Community Prevention:
A Tulsa Coalition’s Approach to Reducing
Non-Medical Use of Prescription Drugs
Coalition Against Prescription and Substance Abuse of Tulsa (CAPSAT)
Conflict of Interest:
Attestation
None of the presenters of this power point have a
financial relationship with any commercial or proprietary
entity that produces health-care related products and/or
services relevant to the content in this presentation. This
includes any financial relationship within the last 12
months, as well as known financial relationships of our
spouses/partners.
Presenters
Lead Presenter: Whitney Kemp Education Coordinator, Oklahoma Center for Poison and Drug Information
Co-Presenter: Floyd Long Transition Coordinator Prisoner Re-Entry Specialist Oklahoma Department of Corrections
Co-Presenter: Matt Condley Prevention Specialist Tulsa Health Department
Coalition Against Prescription and Substance
Abuse of Tulsa (CAPSAT)
Mission : To bring diverse organizations/stakeholders and individuals together to change policies, systems, and environments for the prevention of substance abuse
Objective: The prevention of non-medical prescription drug and opiate/opioid abuse and misuse through education, research, training, intervention, treatment, and enforcement
Mission and Objective
Learning Objectives
Magnitude of prescription drug abuse
Consequences of use
What is CAPSAT doing?
What can you do?
Magnitude of the Problem
A closer look at the epidemic of
non-medical use of prescription
drugs facing our nation, state,
county, and city.
Increasing use of Rx drugs-particularly
opiate/opioid painkillers
In the 1970s/1980s – 2 deaths/100,000 population in U.S.
By 2007 – 1 death every 19 minutes
Rx drugs deaths are second only to motor vehicle accidents
16 States (including Oklahoma by 2009) Rx drug deaths have exceeded motor vehicle crashes
Centers for Disease Control, 2010
A closer look at the non-medical use of
prescription drug epidemic facing the
State of Oklahoma and Tulsa County
Oklahoma
Oklahoma opioid analgesic overdose death rate (age-adjusted)-
12.3/100,000 (National Vital Statistics Surveillance System 2011)
From 2007-2012 Oklahoma had nearly 3,900 overdose deaths (OSDH 2014)
4 out of 5 of these deaths involved at least one prescription drug (OSDH 2014)
Unintentional Poisoning Death Rates Involving at Least One Prescription Opioid by
County of Residence1, Oklahoma, 2007-20122
Cimarron Texas
Beaver Harper
Ellis
Beckham
Woodward
Woods Alfalfa
Major
Dewey
Custer
Washita
Kiowa
Blaine
Caddo
Grant
Garfield
Kingfisher
Kay
Noble
Logan
Canadian Oklahoma
Cleveland
Grady
Osage
McClain
Jackson
Tillman
Comanche
Cotton
Murray
Bryan
Pushmataha
Choctaw
Muskogee
Ottawa
Washington
Nowata
Craig
Mayes
Harmon
Top 5 counties
16.0. – 24.2
11.6 – 15.9
9.6 – 11.5
4.4 – 9.5
<5 deaths
Roger Mills
Greer
Tulsa
Okmulgee
Creek
Okfuskee
Payne
Lincoln
Wagoner Cherokee
Adair
Rogers
Delaware
Carter
Pontotoc
Johnston
Garvin
Love Marshall
Le Flore
Pittsburg
Atoka
Hughes
McIntosh
Latimer
Haskell
Sequoyah
Seminole Potta-
watomie
Rates per 100,000
population
State rate2: 11.9
1County of residence was unknown for 14 persons. 22007-2012 Medical Examiner data
Pawnee
Stephens Coal
Jefferson McCurtain
Tulsa County: A Closer Look 2014
In Tulsa County there are 35.94 prescription painkiller
pills/person (OBNDD 2014)
The most common substances in Tulsa County in overdose
deaths are: Alprazolam, Oxycodone, Methadone,
Hydrocodone, Alcohol, Morphine, Methamphetamine, Cocaine,
Diazepam, and Fentanyl (OSDH 2014)
Tulsa County
Intentional Analgesic Exposure by Age (Poison Control Center 2013)
0.0% 0.4%
8.5%
24.2%
21.2%
17.8%
19.5%
3.8%
1.7% 0.4% 0.0%
2.5%
0.0%
10.0%
20.0%
30.0%
<6 6-12 13-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 >=90 Unknown(adult)
Intentional Analgesic Exposure by Age in Tulsa County (1/1/13-3/31/13)
At Risk At what grade are Tulsa County youth reporting using prescription
drugs for non-medical purposes?
1.9%
5.7%
6.8% 7.0%
1.8%
4.5%
6.2%
7.2%
5.0%
11.2%
13.4%
16.6%
4.2%
9.6%
14.0%
17.4%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0%
6th Grade 8th Grade 10th Grade 12th Grade
30 Day Non-medical Use vs. Lifetime Use
30-Day Use 30-Day Use Lifetime Use Lifetime Use
2008-2012 Oklahoma Prevention Needs Assessment (OPNA)
Tulsa County Non-Medical Use of
Prescription Drugs: Consequence Data
From 2005-2012 Tulsa County had an average rate of 83.95 persons per 100,000 population admitted to treatment for opioid prescription medicines ODMHSAS 2014
There was an increasing admission trend from 2006-2010. In 2006 there were 315 treatment admission for painkiller addiction. By 2010 there were 722 admissions. ODMHSAS 2014
There was a 66.7% increase in treatment for the misuse of painkiller prescription drugs from 2005-2010. ODMHSAS 2014
Opioid Treatment Rates/100,000
2009-2012 Oklahoma and Tulsa County
2009 2010 2011 2012
Tulsa County 104.99 119.31 89.22 104.53
Oklahoma 83.25 88.16 74.65 80.11
ODMHSAS 2014
OKLAHOMA:
An Expensive Problem
$6.7 billion
That is $1,900 for each man, woman, and child in the state
It is enough to create 273,000 median income jobs
It is enough to build 9 skyscrapers
State of Addiction 2012
Tulsa County Non-Medical Use of Prescription
Drugs Consequence Data (continued)
From 1999-2007, Tulsa County opiate overdose deaths was 17.0 deaths per 100,000 population. The state rate was 12.9. (ODMHSAS)
Tulsa County had the 18th highest age-adjusted opiate overdose death rate in the entire US (2010) (ODMHSAS)
Tulsa County ranked 16th in the entire nation for the number of opiate overdose deaths (2010) (ODMHSAS)
In Tulsa County from 2007-2012, there were 552 opiate overdose deaths – an average of 7.67 deaths each month (OSDH)
Tulsa County – Adults ages 45-54 were 2.5 times more likely to die of overdoses than teens and young adults ages 15-24 (OSDH 2007-2012)
Drug Overdoses in Comparison to Motor
Vehicle Accidents in Tulsa County 2009-2011
YEAR MVA DRUG OVERDOSES Rx PAINKILLER OVERDOSES
2009 696 756 547
2010 680 817 500
2011 696 703 456
ODMHSAS 2014
Number of opioid prescriptions filled
City of Tulsa Zip Codes (2013)
Oklahoma Bureau of Narcotics and
Dangerous Drugs, 2013
Number of opioid prescriptions (by doses)
filled: City of Tulsa Zip Codes (2014) (Oklahoma Bureau of Narcotics & Dangerous Drugs 2014)
Oklahoma Bureau of Narcotics and
Dangerous Drugs, 2014
2013-2014 Opioid painkiller consumption by
zip code (Comparison)
2013 (# of prescriptions) 2014 (# of pills)
Health: Addiction, death, brain damage,
major depression, neo natal issues, etc.
Social: loss of family and friends, family
problems, etc.
Financial: Lack of employment, loss of
employment, increased missed days from
employment, lack of finances, etc.
Legal: theft and unauthorized sale of Rx
drugs, jail/prison, attorney fees, etc.
Consequences
Self Reported Use of Opiates for Persons
Screened by Oklahoma Department of
Corrections (2012)
01-10 11-25 26-50 50+ 01-10 11-25 26--50 50+
Lifetime 6 Month
Tulsa County 38.1% 16.9% 10.1% 34.9% 48.2% 24.7% 14.1% 12.9%
Oklahoma 33.4% 15.9% 11.2% 39.5% 45.8% 19.0% 11.2% 23.9%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Oklahoma Prescription Monitoring
Program (PMP)
Enacted into law by the Oklahoma Anti-Drug Diversion Act
(63 O.S. Section: 2-309, 1990)
Oklahoma is credited as the first state to begin using a prescription monitoring program back in the early 90’s. Now Oklahoma has raced to the top again with its high
tech, electronic PMP that boasts real time prescription data sharing beginning this year (2014)
“The PMP application provides continuity between practitioners, pharmacies, and state law enforcement to help prevent prescription fraud in Oklahoma.”
“Designed to deter the abuse of prescription drugs, the statute requires all dispensers of Schedule II, III, IV, and V controlled substances to submit prescription dispensing information to OBNDDC using the ASAP 2007, Version 4, Release 1 standard within 24 hours of dispensing a scheduled narcotic.”
Oklahoma Bureau of Narcotics and Dangerous Drug Control
PMP Quick Facts:
Provides data in real time
Has a greater effect when universal, i.e., all prescribers use it
When actively managed, PMP alerts prescribers when problems are detected, i.e., doctor shopping
Oklahoma Legislation
House Bill 1783
“Effective November 1, 2013, prescriptions for any medication containing hydrocodone may not be refilled.” Oklahoma State Board of Pharmacy
Oklahoma’s Significant Timeline
September 2012- Governor Mary Fallin’s Prescription Drug Task Force Created
February 2013- Finalized State Prescription Plan
October 2013- Distributed Opioid Prescribing Guidelines
December 2013- Governor’s Launch of Rx Plan and Take As Prescribed Media Campaign
April 2014- Naloxone Program Begins (Tulsa Naloxone Pilot Project)
Naloxone
Senate Bill 457
“Allows first responders to administer opiate antagonists without a
prescription when encountering a person exhibiting signs of a drug
overdose; includes prescribing an opiate antagonist to an individual
for use by that individual when encountering a family member
exhibiting signs of an opiate overdose; provides for the Good
Samaritan Act; includes law enforcement, emergency medical
technicians, firefighters and medical personnel at secondary schools
and institutions of higher education.”
Naloxone
Naloxone is a medication called an “opioid antagonist” used to counter the
effects of opioid overdose, for example morphine and heroin overdose.
Specifically, naloxone is used in opioid overdoses to counteract life-
threatening depression of the central nervous system and respiratory
system, allowing an overdose victim to breathe normally.
Naloxone is a nonscheduled (i.e., non-addictive), prescription medication.
Naloxone only works if a person has opioids in their system; the medication
has no effect if opioids are absent.
Naloxone comes in a kit and is administered by being sprayed into the nose. It
is a temporary drug that wears off in 20-90 minutes. As part of an new
initiative, naloxone will be available to first responders as well as available to
the general public. Individuals and family members can contact their family
physician to learn more about access and obtain a prescription.
Oklahoma Department of Mental Health and Substance
Abuse Services (ODMHSAS)/Take As Prescribed Campaign
4 people in Tulsa have been saved
because first responders used
Naloxone
First responders throughout Tulsa
County now carry Naloxone
http://www.newson6.com/clip/1032
7188/increase-in-heroin-use-has-tpd-
officers-carrying-life-saving-kit
Oklahoma Department of Mental Health and
Substance Abuse Services (ODMHSAS)/TPD
Naloxone Quick Facts:
What is CAPSAT?
Composed of Tulsa citizens who have an interest in reducing the non-medical
use of prescription drugs.
Funded by ODMHSAS, SAMHSA, and CSAP with Strategic Prevention Framework
State Incentive Grant
Tasked with developing a plan to reduce prescription drug abuse and reduce
opiate analgesic (painkillers) overdose deaths
Conducted an assessment in Tulsa County to determine areas in which the
problem appeared to be centered
Developed a work plan and strategies to fight this epidemic. Strategies use
the public health approach of population change through changing the
environment which may be conducive to substance use/abuse
CAPSAT STRATEGIES
Proper storage of prescription drugs through educational presentations,
distribution of lock boxes, use of media to develop awareness
Proper disposal of prescription drugs through educational presentations, take-
back events, distribution of disposal bags, increasing awareness of permanent
drop off sites
Awareness campaign, including Naloxone
What is CAPSAT doing? Community Education/Presentations
- Safe/Secure Storage of Prescription Drugs (Pact 360 Rx Video,
Distribution of Rx Lock Boxes w/Individual Pledge & Policy to Safely Store Rx Meds,
Pre/Post Survey, Rx handouts/information)
- Proper Disposal of Prescription Drugs (Pact 360 Rx Video, Distribution of
Personal Rx Disposal Bags w/Individual Pledge & Policy to Properly Store Rx Meds,
Pre/Post Survey, Rx handouts/information, creating awareness of OBNDD Permanent
Disposal Boxes)
Rx Take Back Days for the community-partnership with OBNDD,DEA, Walgreens, Reasors, Save A
Lot, etc. (Fall & Spring)
Community Surveys
Safe Storage & Proper Disposal Policy Advocacy
Rx Data Collection - ongoing
Media Awareness Campaign (Rx Safe/Secure Storage & Proper Disposal of Rx Drugs)
CAPSAT Website (www.capsat.org)
OKLAHOMA ADULT PRESCRIPTION DRUG
SURVEY (TULSA COUNTY) 2012
What do you do with your left over prescription
drugs?
Save them for use later 51.6%
Flush them/Throw in trash 48.4%
Take to a drug drop box 9.3%
Take to a drug take back event 4.7%
OKLAHOMA ADULT PRESCRIPTION DRUG
SURVEY (TULSA COUNTY) 2012
When asked:
“Do you keep your prescription medicines in a
locked, secure cabinet?”
57.4% said No
Tulsa County
Permanent Drug Drop-Off Sites Tulsa Police Department, Gilcrease Division 3436 N. Delaware, Tulsa 74110
Tulsa Police Department, Mingo Valley Division, 10122 E. 11th Street, Tulsa 74128
Tulsa Police Department, Riverside Division, 7515 S. Riverside Drive, Tulsa 74136
Tulsa County Sheriff, 303 W. 1st Street, Tulsa 74103
Bixby Police Department, 116 W. Needles, Bixby 74008
Broken Arrow Police Department, 1101 N. 6th , Broken Arrow 74012
Collinsville Police Department, 1023 W. Center, Collinsville 74021
Glenpool Police Department, 14536 S. Elwood, Glenpool 74033
Jenks Police Department, 211 N. Elm, Jenks 74037
Owasso Police Department, 111 N. Main, Owasso 74055
Skiatook Police Department, 220 S. Broadway, Skiatook 74070
Sand Springs Police Department, 100 E. Broadway, Sand Springs 74063
Media Campaign to inform public on the epidemic of prescription-related
deaths
Encourage presentations to educate on proper storage and disposal of prescription
drugs
Promote public reporting of drug diversion to Oklahoma Bureau of
Narcotics and Dangerous Drugs Control
Promote 211 information helpline to public to obtain referrals for addiction
treatment
Individuals & Communities Can
Create Environmental Change
Everyone can: Secure your prescription medications; especially opiates, in a safe manner. (Our
recommended method is a prescription drug lock box)
Avoid taking prescription painkillers more often than prescribed.
Dispose of medications properly, as soon as the course of treatment is done, and avoid keeping prescription painkiller or sedatives around “just in case.” (Our recommended method is personal disposal bags or OBNDD permanent disposal boxes-located at your local police department/sheriff’s office.
Help prevent misuse and abuse by not selling or sharing prescription drugs.
Never use another person’s prescription drugs.
Get help for substance abuse problems 2-1-1 or 1-800-662-HELP.
Call Oklahoma Poison Control Center 1-800-222-1222 if you have questions about medicines.
WHAT HAS CAPSAT DONE?
Achievements
146 lock boxes distributed
150 individual pledges/policies
10 community presentations – in FY 14
Hispanic Outreach (Presentations at Saints Peter & Paul, St. Xavier, Catholic Charities)
2 community surveys
Rx Take Back Events (1 of which had the largest amount of meds taken back in the State) 2013- 411 pounds
Only Rx Prevention Coalition w/in Tulsa *community mobilization w/in a short period of time
Future CAPSAT Events
Rx/opiate water study
Upcoming Rx Take Back Day (October 18, 2014 at
Reasor’s, 71st & Sheridan)
Upcoming Community Events
Mayor Bartlett’s Rx Summit (Oct. 17, 2014)
Expected Outcomes
Change in attitudes and behavior with respect to storage and disposal of prescription drugs
Increased knowledge of permanent disposal sites
Please join CAPSAT in our
efforts!
CAPSAT meets the second Wednesday of every month at
1:30pm
October 8, 2014 (Hardesty Library, Pecan Room)
November 12, 2014 (North Regional Health & Wellness Center, Rm
210)
December 10, 2014 (Hardesty Library, Pecan Room)
TULSA COUNTY AND OKLAHOMA STATE OPIOID
TREATMENT RATES/100,00, 2012-2013
2012 2013
TULSA COUNTY 104.53 77.12
OKLAHOMA 80.11 62.64
Opioid Analgesic Overdose Death Rate/100,000
2009-2011
Tulsa County Oklahoma
2009 18.8 15.0
2010 17.9 13.6
2011 11.5 12.3
CAPSAT Partners
“Local People Solve Local Problems”
McGee Enterprises
For more information, please contact:
Whitney Kemp, CAPSAT Co-Chair
405-522-0075
Stephanie Tillman, SPF SIG Coordinator
918-595-4468
Website: www.capsat.org