A project that explains the prevalence of prescription drug misuse, specifically among the young adult population. Includes information on warning and behavioural signs of prescription drug abuse, commonly abused prescription drugs, cultural awareness, and related policies and prevention strategies.

1. Among Young Adults
PRESCRIPTION DRUG MISUSE

2. Background
 Prescription drug misuse is taking drugs without
a prescription and taking drugs for something
other than its intended purpose; for example, to
experience a change in mood [National Institute
on Drug Abuse (NIDA), 2014; Weekes, Rehm, &
Mugford, 2007].
 Prescription drug misuse is highest amongst
young adults aged 18 to 25 (NIDA, 2014).
 According to NIDA (2014), 5.9% of young adults
used prescription drugs for non-medical use in
the last month.

3. (Lyons, 2013)

4. Methods for obtaining and
misusing prescription medication
 getting prescription from a single practitioner
 getting prescription from more than one practitioner;
also known as double-doctoring or doctor shopping
 prescription fraud
 Internet purchases
 purchases from street drug markets
 purchasing from family and friends who were
legitimately prescribed
 fraudulent prescriptions written by practitioners
 healthcare providers taking medication intended for
patients
("Prescription Opioids," 2013; Weekes et al., 2007)

5. Most common misused
prescription medication
 Opioids
 Central Nervous System (CNS) depressants
 Stimulants

6. (National Institute on Drug Abuse, 2014)

7. Opioids
 usually referred to as painkillers or narcotics
 mainly used to treat acute and chronic pain
 may be used to control persistent cough and
diarrhea
 may also be used for the treatment of opioid
addiction; for example, methadone
 Examples of prescription opioids:
 morphine
 oxycodone
 codeine
 fentanyl
 hydromorphone
 Hydrocodone
("Prescription Opioids," 2013)
(Toby Talbot/Associated Press, 2014)

8. Available forms of opioids
 tablets
 capsules
 skin patches
 nasal sprays
 liquids for injection
 suppositories
(Government of Canada, n.d.; "Prescription Opioids," 2013)

9. Prescription opioid statistics
 Canadians are the world’s second leading customer of
prescription opioids after Americans (Government of
Canada, n.d.).
 “Prescription analgesic abuse is the second leading reason
for admission to substance treatment programs” (Taylor &
Stuart, 2013, p. 448).
 In British Columbia, the rate of prescription opioid-
associated deaths is comparable to the number of people
killed in motor vehicle accidents involving alcohol. This is
roughly 2 to 3 per 100,000 people in any given year
("Prescription Opioids," 2013).
 In Ontario, emergency room visits linked to “narcotics
withdrawal, overdose, intoxication, psychosis, harmful use
and other related diagnoses” increased by about 250% from
2005–2006 to 2010-2011 ("Prescription Opioids," 2013, p.
4).

10. Physical signs and symptoms of
prescription opioid abuse
 Opioid Analgesics: treat moderate to severe pain; includes
Vicodin, OxyContin and Percocet (Oxycodone +
Acetaminophen)
 Sleep deprivation, nodding
 Constricted pupils, watery or droopy eyes
 Nausea, vomiting
 Constipation
 Slow, slurred speech
 Slow gait
 Dry skin, itching, skin infections
 Regular flu-like symptoms
 Track marks
(National Council on Patient Information and Education, 2009)

11. Central nervous system depressants
 Central Nervous System (CNS) depressants
(also referred to as sedatives and
tranquilizers) are:
 medications that slow brain activity
 used for anxiety and sleep disorders
 used to induce sedation for medical procedures
 used to treat alcohol withdrawal
 used to control seizures
 used to relax skeletal muscles
(NIDA, 2014; "Prescription Sedatives And Tranquilizers," 2013)

12. Examples of CNS depressants
 Benzodiazepines
 Alprazolam (Xanax), Clonazepam (Rivotril),
Diazepam (Valium)
 Non-benzodiazepines sleep medications
 Eszopiclone (Lunesta), Zopiclone (Imovane),
Zopidem (Ambien),
 Barbiturates
 Amobarbital (Amytal), Mephobarbital (Mebaral),
Pentobarbital (Nembutal)
(NIDA, 2014; "Prescription Sedatives And Tranquilizers," 2013)

13. Prescription CNS depressants
statistics
 Women are more likely to be prescribed
tranquilizer; for example, to cope with stress
and grief or to adjust to childbirth and
menopause ("Prescription Sedatives And
Tranquilizers," 2013).
 “In 2010-2011, 1.5% of Canadian students in
grades 6 to 12 reported past-year use of
tranquilizers to get high and not for medical
purposes” ("Prescription Sedatives And
Tranquilizers," 2013, p. 3).

14. Physical symptoms and signs of
prescription CNS depressants abuse
 Sedatives/Depressants: treat anxiety, panic
attacks and sleep disorders; includes Valium,
Xanax and Ambien.
 Deficiency in coordination
 Respiratory depression
 Slowed reflexes
 Slurred speech
 Coma
(National Council on Patient
Information and Education, 2009) (Addiction Research, 2015)

15. Stimulants
 Produces a euphoric effect
 increases wakefulness
 increases alertness
 increases focus
 increases attention
 used to treat number of health conditions,
including
 asthma
 sleep disorders
 obesity
 attention deficit/hyperactivity disorder
(Coalition on Prescription Drug Misuse, 2010; "Prescription Stimulants," 2013)

16. Examples of prescription
stimulants
 Methylphenidate
 Dextroamphetamine sulfate
 Amphetamine and dextroamphetamine
("Prescription Stimulants," 2013)

17. (Lamparter, 2014)

18. Physical signs and symptoms of
prescription stimulant abuse
 Stimulants: treat ADHD or narcolepsy; includes
Adderall and Retalin
 Hyperactivity
 Shaking
 Sweating
 Dilated pupils
 Increased heart rate
 Increased body temperature
 Seizures
 Paranoia, anxiety
 Repetitive behaviours
 Loss of appetite and/or weight loss
(National Council on Patient Information and Education, 2009)

19. (Scholastic Inc, 2003)

20. Potential reasons for
prescription drug abuse
 Unlike illegal drugs and substances, it is easier and cheaper to get
prescription drugs.
 For example, people who receive social assistance and people who have drug plans
are able to have their prescription drugs paid for (Weekes et al., 2007).
 There is belief that prescription drugs are safer than illegal or street
drugs because prescription drugs are produced by pharmaceutical
companies rather than in dirty labs by untrained people (Weekes et al.,
2007).
 Many prescription drug users believe that they are less likely to be
caught by law enforcement authorities when carrying legitimate-looking
medications (Weekes et al., 2007).
 Some individuals who misuse prescription drugs have developed
addiction from taking prescribed drugs for medical purposes (Coalition
on Prescription Drug Misuse, 2010).
 Prescription medications is one of the contraband products that increase
in cost when re-sold (Weekes et al., 2007).
 For example, a Vancouver study confirms that a 60 mg tablet of MS Contin has an
average of 2059% markup street value and a 4mg Dilaudid tablet has an average of
7800% markup street value (Weekes et al., 2007).

21. Warning signs for prescription
drug abuse/misuse
 Rapid mood changes, such as irritability, negative attitude, altered
personality
 Extreme changes in groups of peers/friends or hangout locations
 Forgetfulness or clumsiness
 Lying, deceitfulness, skipping classes/missing work, and avoiding
eye contact
 Detachment from or no concern for personal appearance,
extracurricular activities, or sports
 Increased craving for food, or having the “munchies”, rapid
changes in appetite
 Uncommonly poor performance, such as in school or in activities
 Borrowing money, having extra cash
 Behaving angrily or abusive, reckless behaviour
(National Council on Patient Information and Education, 2009)

22. Assessments
 The Drug Abuse Screening Test (DAST)
 Developed in 1982 and is an effective screening tool
still today
 Comprises of self-reporting 28 items
 Known to present “valid psychometric properties” and
is recognized as “a sensitive screening instrument for
the abuse of drugs other than alcohol”
(“Substance Abuse Screening Instrument”, n.d.):
 Drug Use Disorders Identification Test (DUDIT)
 Objective “is to identify use patterns and various drug-related
problems”
 Comprises of self-reporting 11 items
 Each item has a focus, such as for question “Over the past year,
have you felt that your longing for drugs was o strong you could
not resist it?” focuses on craving.
(Berman et al., 2003)

23. The DAST
Shapiro et al., 2013

24. Myths and facts
 Some myths about prescription drugs misuse among young
adults are the following:
 prescription medications are a safer alternative to illicit street
drugs like cocaine or heroin.
 Prescription medication is government approved and many have
seen their parents and grandparents and other family members
take these medications prescribed by their doctor.
 it is not a big deal because everyone is doing it.
 society also tends to think young adults often get prescription
medications from drug dealers on the street.
 nothing bad will happen to them or their friends if they use non
prescription drugs.
 The facts to these matters are prescription drugs, when
misused or taken without a doctor’s prescription, can be
just as harmful as illegal street drugs.
 Taking these medications together with alcohol or other
drugs, as many college students do, can have grave and
possibly deadly consequences.

25. More facts…
 Research shows that students who take prescription drugs for
nonmedical reasons are at least five times more likely to develop a drug
abuse problem than those who do not (Cherry, 2015).
 Only a small percentage of young adults do this according to the
statistics, but dangerous nonetheless. It is also a fact that most students
do not get the drugs from the drug dealers on the street, rather from
their friends, classmates and family.
 That’s because many of the most abused prescription medications widely
prescribed for legitimate medical conditions are readily available.
 Majority of students are able to access stimulants from home, their
peers or friends.
 Another reality is that every college student, even the most
accomplished is vulnerable. Once away from home, students are subject
to the temptations and demands of college life without parental
supervision and support, could succumb to the influence of peer
pressure.
 According to Erikson's psychosocial development model, there is the
need for young adults to form intimate, loving relationships with other
people, success leads to strong relationships, while failure results in
loneliness and isolation" (Cherry, 2015).

26. Myth
(Benzodiazepines, 2009)

27. Fact…
(Burnett, 2014)

28. Culture and Prescription Drug Misuse
 In North America, prescription drug use disorders
is two to four times greater among Aboriginal
peoples than the general population (Currie et
al., 2013)
 In a study of 371 Aboriginal peoples, close to 25%
of participants revealed non-medical or misuse of
prescription drugs (Currie et al., 2013):
 56.5% of these individuals reported obtaining
prescriptions from their physicians.
 Significant number of people revealed obtaining
prescription medication by buying from others, using
another person’s prescription, and by having
prescriptions written by pharmacists.

29. College Students
 According to the Addictions Center (2015),
drug abuse is prevalent among college
students to a great extent.
 Unfortunately, those enrolled in full-time
studies are twice more likely to abuse drugs
and alcohol (2015).
 A consistently abused prescription drug
among college students is Adderall (2015).

30. (Interadmin, 2013)

31. Factors associated with drug misuse among
collegestudents
 Stress
 Coursework
 Part-time jobs
 Internships
 Social obligations
 Course load
 Linked to significant high use of stimulants, like Adderall
 Curiosity
 Not unusual for self-exploration to delve into drug
experimentation
 Peer Pressure
Addiction Center, 2015

32. Policies
 Policy on the prevention of non-medical use of prescription drugs
must meet the constraint that the drugs are available to those
who need them, and the twin constraints of prevention and
availability be established and implemented at different levels .
 It is important to keep in mind during policy design that it is a
public health issue that requires a response from the public health
system, rather than from the law enforcement or criminal justice
system.
 The Centre for Addiction and Mental Health (CAMH) in Canada
offers that the field of prescription drug control especially from a
criminal justice end is in a state of early formation and hence
counterproductive measures can still largely be avoided at this
point.
(United Nations Office on Drugs and Crime, 2011)

33.  Secondly, given that many current non-medical users of
prescription drugs in Canada are young people, the possible
criminalization of nonmedical users might do more harm than
good by way of criminal labeling and stigma effects, can lead to
foreclosing social, professional and educational opportunities,
which may be far more severe than the actual benefits
accomplished through such user enforcement.
 The non-enforcement or elimination of active user criminalization
has been repeatedly and authoritatively recommended (CAMH,
2009).
 The policy design looks at the final consideration which refers to
the current realities and profiles of sources of prescription drugs,
whether for medical or non-medical use in a globalized Canada in
the 21st century are currently bought or obtained via the Internet.
 Finally, key component in the wider policy debate regarding
possible legal and regulatory control mechanisms towards non-
medical prescription drug use concerns tighter control of medical
care and drug providers (physicians and pharmacists), by way of
more intensive scrutiny or auditing regarding compliance with
drug control, prescribing, dispensing and reporting requirements,
as well as different models or variations of ‘prescription
monitoring programs’ (PMPs).
(UNODC, 2011)

34. Prevention
 Prevention must start with community education, interventions
specific to the non-medical use of prescription drugs to address
the complexity of this ever increasing problem.
 Specific interventions targeting parents should be developed.
These might include:
 promoting simple safety measures about how to store prescription drugs
safely
 raising awareness about the dangers of providing their children with
prescription drugs that have not been prescribed for them
 monitoring their child’s use of prescription drugs for medical or non-
medical purposes
 Prevention programs that seek to minimize use among children
and young people, and which deters the young adult population,
with a special focus on the college population on the use of
prescription drugs for cognitive enhancers and recreations.
 Best practice training protocols for health-care workers are
needed to be able to identify predictors of risk and protective
factors for the nonmedical use of prescription
(UNODC, 2011)

35. Watch video
 Open the link provided below and watch a
video regarding the prevalence of prescription
opioid abuse among young adults. Use of
opioids, like OxyContin and cedeine, is one of
the leading causes of death among young
adults – noted as “a substantial burden of
disease” (Zafar, 2014)
http://www.cbc.ca/news/health/oxycontin-and-
other-opioids-tied-to-1-in-8-deaths-in-young-
adults-ontario-study-shows-1.2696995

36. Treatment and interventions
 When looking for treatment for young adults when
they are misusing prescription drugs, the needs of
the person must be taken into consideration in
addition to the type of drug that was misused
 The treatment can include the use of several types of
methods such as detoxification, counselling and
sometime can include medications in order to
manage the individual's withdrawal symptoms
 Two approaches for treating prescription drug abuse:
 Behavioural
 Pharmacological
[National Institute for Drug Abuse (NIDA), 2014]

37. Behavioural approach
 The behavioral method is based on changing
the behavior around drug use and give
individuals misusing prescription medication
ways to cope without the drugs, deal with the
cravings and to stay away from the situations
that had led them down that path in the first
place and, lastly, what to do if they return to
their misusing behaviour
(NIDA, 2014)

38. Pharmacological approach
 The pharmacological approach is to use
medication to counteract the effects of
withdrawal.
 This presents a conundrum in that the drugs
are the problem; however, they help to
counteract the symptoms and are not
addictive
(NIDA, 2014)

39. Recovery and mental
health services
 A program, such as a 12 step program, is one way to start the
process of recovery to encourage abstinence. When an individual
is in a step program, the goals are to accept the fact that drug
addiction can occur easily and the person has no control over
their life. The individual needs to “let go” and let the process
occur to begin the stages of recovery, and the final phase is to
participate actively in meetings and activities (Drugabuse.gov,
2012).
 CBT is another option in addition to help. CBT will help an
individual change their behaviors when they are faced with
situation in which they feel stressed or anxious and it will provide
them with alternative coping mechanisms. By doing CBT therapy
an individual will be able to learn about the positive and negative
results from their actions, give them insight into the reasons for
why they are using prescription drugs and to help them to gain
control over their lives and to problem solve (Mental Health and
Substance Use, 2015).

40. References
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https://www.addictioncenter.com/college/
Addiction Search. (2015). The dangers of ambien abuse and addiction. Retrieved from
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addiction_142.html
Benzodiazepines. (2009). Benzodiazepines and barbiturates. Retrieved from
http://mysedativeaddiction.blogspot.ca/
Berman, A. H. et al. (2003). The drug use disorders identification test manual. Retrieved from
http://www.paihdelinkki.fi/sites/default/files/duditmanual.pdf
Center for Addiction and Mental Health (2009). An overview of non-medical use of prescription drugs and
criminal justice in Canada. Retrieved from http://www.justice.gc.ca/eng/rp-pr/cj-jp/victim/rr13_16/rr13_16.pdf
Cherry, K. (2015). Erikson's psychosocial stages summary chart. Erikson's stages of psychosocial development.
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Chart.htm
Coalition on Prescription Drug Misuse. (2010). About rx drug misuse. Retrieved from
http://www.prescriptiondrugmisuse.ca/about-rx-drug-misuse/
Currie, C. L. et al. (2013). Illicit and prescription drug problems among urban Aboriginal adults in Canada: The role
of traditional culture in protection and resilience. Retrieved from
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Interadmin. (2013). Adderall abuse and prescription addiction in college. Retrieved from
http://interventionstrategies.com/adderall-abuse-and-prescription-addiction-in-college/

41. Lamparter, C. (2014). Adderall abuse on college campuses. Retrieved from
http://smartgirlsgroup.com/uncategorized/2014/10/adderall-abuse-on-college-campuses/
Lyons, J. (2013). Infographic: Abuse of prescription drugs affects young adults most. Retrieved
from http://hin.com/blog/2013/07/26/infographic-abuse-of-prescription-drugs-affects-young-
adults-most/
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43. United Nations Office on Drugs and Crime (2011). The non-medical
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1.2696995

44. By Aman Khosa, Irene Kumar, Kam Dhaliwal and TJ Ahmed.