Prescription and Over-the-Counter Drug Abuse Orange County

Transcription

Acknowledgements
This comprehensive report presents the distilled research and critical thinking of a diverse group
of local experts in the alcohol and other drug prevention field. The County of Orange Health
Care Agency’s Alcohol and Drug Education and Prevention Team (ADEPT) would like to thank
these leaders for their dedication to the field and for their thoughtful insights throughout this
process.
Orange County Prescription Drug Task Force
Prescription Drug Strategic Planning Session Attendees
In addition, a very special thanks to the following individuals and agencies for their contributions
to this report:
Community Service Programs, Inc.
Project Positive Action Towards Health (PATH)
Erica Leary, MPH
North Coastal Prevention Coalition
Michelle Poisson
County of Orange Health Care Agency
Alcohol and Drug Education and Prevention Team (ADEPT)
National Council on Alcoholism and Drug Dependence-Orange County
Community Alliance Network (CAN)
Romeo Howe
Consultant
For more information regarding the County of Orange Health Care Agency’s Prescription and
Over-the-Counter Drug Abuse Prevention Initiative, please contact:
Stacey Zapanta, MPH, CHES
Alcohol and Drug Education and Prevention Team (ADEPT)
405 W. 5th St., Suite 211, Santa Ana, CA. 92701
(714) 834-4369 or [email protected]
A copy of this Report is available online at: http://ochealthinfo.com/adept/publications
Table of Contents
I. Introduction.................................................................................
1
II. Orange County Multidisciplinary Workgroup...............................
2
III. Overview of Prescription and Over-the-Counter
Drug Abuse.................................................................................
3
IV. Scope of the Problem in Orange County.................................... 11
V. Orange County Town Hall Meetings........................................... 23
VI. Partnership for a Drug-Free Orange County.............................. 44
VII. Strategic Planning Session......................................................... 45
VIII. Conclusion.................................................................................. 50
IX. References................................................................................. 51
X. Appendix A: Orange County Prescription Drug Task Force........ 53
XI. Appendix B: Description of Data Sources................................... 54
XII. Appendix C: School Districts and Schools in Orange County
by Region.................................................................................... 57
XIII. Appendix D: Orange County Rx/OTC Lifetime Use Rates
by Region.................................................................................... 62
XIV. Appendix E: Orange County Rx/OTC Lifetime Use Rates by
Rx/OTC Drug.............................................................................. 65
XV. Appendix F: Strategic Planning Session Participants................. 67
Orange County Comprehensive Report
Introduction
The nonmedical use and abuse of prescription and over-the-counter drugs to get high is a
serious and growing public health problem throughout the Nation. While the use of illegal
substances like methamphetamine, heroin, and marijuana has declined over the past decade
abuse of prescription and over-the-counter drugs has increased sharply. According to the
most recent Partnership for a Drug-Free America’s annual tracking survey, one in five teens
report having abused a prescription drug to get high, and one in ten young people report
having abused over-the-counter cough medicines to get high (PATS, 2009). In Orange County,
California, teen drug abuse of these drugs is either on par or higher than national trends.
In regard to prescription drugs, 17% of 11th grade students report having used prescription
painkillers at least once in their lifetime, whereas significantly more (19% or one in four) young
people in Orange County report using or trying over-the-counter cough and cold medications at
least once to get high (CHKS, 2008).
What is so troubling about the abuse of these drugs, is the ease of obtaining these medications
and the misperception that these drugs provide a “safe” high – after all, these drugs are
prescribed by your family physicians, are available over the counter from the pharmacy down
the street, or they are simply sitting at home in your medicine cabinet. In 2007, the National
Survey on Drug Use and Health (NSDUH) found that over half (54%) of individuals reporting
nonmedical use of psychotherapuetics got them “from a friend or relative for free” (SAMHSA,
2008). While the proper use of these drugs can be lifesaving, the consequences of their abuse
can be as dangerous as those from illegal drugs, leading to emergency department visits and
deaths. In fact, unintentional poisoning deaths involving psychotherapeutic drugs, such as
sedatives and antidepressants, grew 84% from 1999 to 2004 (CDC, 2007).
In July 2008, based on this growing concern around the abuse and misuse of prescription
and over-the-counter drugs, the County of Orange Health Care Agency’s Alcohol and
Drug Education and Prevention Team (ADEPT) received funding from the Tobacco
Settlement Revenue (TSR) Committee to identify the scope of the problem in Orange
County, raise awareness about the issue of prescription drug abuse, and identify prevention
recommendations. The funding was a one-time amount given for a yearlong initiative.
ADEPT proposed to engage the three regional county-funded providers already doing work
around alcohol and other drug abuse prevention in an effort to more efficiently and effectively
address this issue on a countywide level. The subsequent Prescription Drug Initiative had five
objectives to be completed by June 30, 2009, which included: (1) developing a multidisciplinary
workgroup or task force to lead this countywide effort; (2) utilizing the workgroup/task force
to identify the scope of the prescription drug abuse problem; (3) conducting at least three
town halls to increase community awareness about the issue; (4) engaging local media; and
(5) conducting a Strategic Planning Session in which prevention recommendations for next
steps could be developed. All five objectives have subsequently been completed and are
described within this report.
Prescription and Over-the-Counter Drug Abuse
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Orange County Multidisciplinary Workgroup
In November 2008, the County of Orange Health Care Agency’s Alcohol and Drug Education
and Prevention Team (ADEPT) convened a multidisciplinary group of county funded providers,
community stakeholders, and other agencies involved in statewide or countywide prescription
drug prevention or diversion efforts to begin addressing the issue of prescription and overthe-counter drug abuse in Orange County. The multidisciplinary workgroup was charged with
completing the following objectives: (1) identify the scope of the problem in Orange County; (2)
convene at least three town hall meetings to increase awareness amongst parents and youth
about the problem; and (3) develop next steps and prevention recommendations for the County.
The workgroup met on a monthly basis for the year-long project and ultimately became the
Orange County Prescription Drug Task Force. The Task Force decided from the start that
they would fold over-the-counter drugs into the scope, as the issues were so interrelated
with prescription drug abuse. Additionally, even though the Task Force acknowledged that
prescription and over-the-counter drug abuse was not just an issue amongst young people, in
order to most efficiently address the year long project, that the focus would be on identifying
the problem of prescription and over-the-counter amongst youth and young adults’ aged 12-25
years.
Appendix A identifies all individual members of the workgroup, but the following agencies were
represented:
• Abbott Pharmaceuticals, Inc.
• Bureau of Narcotic Enforcement/Professional Diversion Investigators Network (BNE/PDIN)
• California National Guard – Drug Demand Reduction (DDR)
• Community Alliances for Drug Free Youth (CADFY)
• Community Service Programs, Inc. - Project Positive Action Towards Health (CSP-PATH)
• County of Orange Health Care Agency, Alcohol and Drug Abuse Services, Prevention Team
(ADAS-Prevention)
• County of Orange Health Care Agency, Alcohol and Drug Education and Prevention Team
(ADEPT)
• Fourth District Parent-Teacher-Association (PTA)
• National Council on Alcoholism and Drug Dependence-Orange County – Community Alliance
Network (NCADD-OC)
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Overview of Prescription and Over-the-Counter Drug Abuse
Although many prescription drugs can be abused, the most common classifications of
medications abused by youth include opiates, central nervous system depressants, and
stimulants. In regards to over-the-counter drugs, the most commonly abused are cough and
cold medications containing dextromethorphan (DXM).
Opiates
Opiates, sometimes referred to as narcotics, are a
group of drugs which are used medically to relieve pain,
but also have a high potential for abuse. Americans,
constituting only 4% of the world’s population, consume
80% of the global supply of opiods and 99% of the global
supply of hydrocodone (Califano, 2007). Prescriptions
for opiates (hydrocodone and oxycodone products) have
escalated from around 40 million in 1991 to nearly 180
million in 2007.
Opiates are made from opium, a white liquid in the poppy plant, similar to heroin, but these
prescription drugs are produced in laboratories. Taken as directed, opiates are very effective
analgesics or pain relievers, but they also create a quick, intense sense of euphoria.
The most commonly known prescription opiates are Vicodin® and Oxycontin®. Other examples
include: morphine (Kadian®, Avinza®), codeine, oxycodone (Oxycontin®, Percodan®, Percocet®),
hydrocodone (Lortab®, Lorcet®, Vicodin®), propoxyphene (Darvon®), fentanyl (Duragesic), and
hydromorphone (Dilaudid®). There are numerous slang terms for the various opiates. Some
include: syzurp (codeine), oxy (Oxycontin), O.C.’s (oxycontin), and hillbilly heroin (oxycontin).
Central Nervous System (CNS) Depressants
CNS depressants slow down normal brain functioning, and are often referred to as sedatives.
There are two types of CNS depressants – barbiturates and benzodiazepines – and these are
used primarily to treat anxiety and sleep disorders. In higher doses, some CNS depressants can
be used as general anesthetics.
Common CNS depressants include: barbiturates,
mephobarbital (Merbaral®), pentobarbital sodium
(Nembutal®), butalbital (Fioricet®), benzodiazapines,
diazepam (Valium®), chlordiazepoxide HCI (Librium®),
alprazolam (Xanaz®), triazolam (Halcion®), and
estazolam (ProSom®). There are numerous slang terms
for the various opiates – tranks (benzodiazepines),
downers (benzodiazepines), V’s (valium®) and Z bars
(xanax®).
Stimulants
Stimulants are a class of drugs that enhance brain activity and increase alertness, attention,
and energy, as well as elevate blood pressure, heart rate, and respiration. These medications
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historically were used to treat asthma and respiratory problems, obesity, and a variety of other
ailments, but as their potential for abuse and addiction became apparent, the medical use
began to decrease. Now they are prescribed for a few health conditions, including treatment of
narcolepsy and attention deficit hyperactivity disorder (ADHD). Common prescription stimulants
include: adderall, dextroamphetamine (Dexedrine®), and methylphenidate. Slang terms for
stimulants include: dexies (dextroamphetamine), and for adderall – addy, alls, bennies, amps,
a-bombs, and “the A train.”
Over-the-Counter (OTC) Medications
The most commonly abused over-the-counter medications that young people are abusing are
cough and cold medications which contain the ingredient dextromethorphan or DXM. DXM
is a semisynthetic narcotic, and is found in well over 100 brand-name and store-brand OTC
cough medicines. When used according to label directions, DXM is a safe and effective cough
suppressant. At much higher doses (typically more than 360 milligrams), DXM produces
dissociative effects similar to those of PCP (phencyclidine) and ketamine and can have serious
health effects which can vary from vomiting to rapid heart rate to slowed breathing and even
death (Bobo et al, 2006). Additionally, of concern, are the adverse reactions from overdosing
on other ingredients in the cold remedies with DXM, such as acetaminophen, pseudoephedrine
and antihistamines, which can cause liver damage, irregular heart beats, high blood pressure
and seizures (Bryner et al, 2006).
DXM is available in syrups, capsules, gel caps, lozenges, and the powder form (pure DXM) can
be bought via the internet. There are numerous slang names for DXM, such as CCC, triple C,
Dex, Poor Man’s PCP, skittles and robo, which often refer to particular brand name products.
About two-thirds of abusers now take Coricidin HBP Cough & Cold, whose candy-red tablets are
nicknamed red devils, triple C and skittles. “Robotripping” takes its name from Robitussin, the
second most abused cold medicine (Banerji et al, 2001).
Polydrug Use
A common practice of young people when taking prescription or
over-the-counter drugs is to combine them with each other and/
or other drugs, such as alcohol. This is called “polydrug use”
and the setting in which this can take place is called a “pharming
party.” At these parties or gatherings young people trade or
exchange prescription medications to get “high,” by tossing all the
prescription drugs they can acquire into a communal bowl (aka
“trail mix”) and then they down them “by the fistful” to get high.
This practice can be extremely harmful and even deadly. The
most frequent substance found in combination with prescription
and over-the-counter drugs is alcohol, but no matter what the
drug, the consequences can be extremely harmful, slowing both
heart and respiration, and could even lead to death (DAWN,
2004).
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Prevalence of Use
National surveys and research reports have identified youth prescription and over-the-counter
drug abuse as a growing concern in the United States. The abuse of prescription drugs has
outpaced the use of all illegal drugs except marijuana among teens – in fact, there are more
teens that abuse prescription drugs than cocaine, heroin, and methamphetamine combined
(ONDCP, 2008). While the abuse of many illicit drugs has declined in recent years, abuse rates
of prescription and over-the-counter drugs have increased or remained steady at peak rates
(MTF Survey, 2008).
Although prescription and over-the-counter drugs are generally viewed as safe, the misuse of
these drugs is not without consequences. Across the nation there has been a dramatic increase
in the number of poisonings and deaths attributed to the abuse of these drugs (ONDCP, 2008).
These national trends indicate that prescription and over-the-counter drug abuse poses a threat
to public health and safety.
National Prevalence
In 2008, 4.7 million teens, or about 19%, reported that they had abused prescription drugs at
some point in their lives. Figure 1 shows the lifetime use rate qualifies prescription drugs as the
second most commonly abused substance among teens (PATS, 2008).
Source: Partnership Attitude Tracking Study, 2008
Additionally, national trends in the misuse of prescription drugs among teens do not coincide
with trends seen for other commonly abused substances. While the abuse of illicit drugs,
alcohol, and cigarettes among teens has significantly decreased in recent years, the abuse
of prescription drugs has remained relatively steady (PATS, 2008). Prescription and OTC
medications were the most commonly abused drugs by high school students after marijuana. In
addition, they represent 6 of the top 10 illicit drugs reported by 12th graders (MTF, 2008).
Research reveals that painkillers are the most commonly abused prescription drugs among
teens, with approximately 10% of teens reporting lifetime use (PATS, 2008). In 2008, 9.7% of
12th graders reported having used a prescription painkiller within the past 12 months, compared
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to 6.7% of 10th graders and 2.9% of 8th graders. Vicodin® and Oxycontin® are the most
frequently abused prescription painkillers. While the use of Vicodin® has remained relatively
constant at historically high levels since 2002, the number of teens reporting past year abuse of
Oxycontin® increased 30% between 2002 and 2007 (MTF, 2007).
Source: Monitoring the Future, 2007
In addition to prescription drugs, teens are abusing over-the-counter (OTC) cough and cold
medications to get high. In 2008, 10% of youth (or 2.4 million young people) in the United States
reported having used cough and cold medicines to get high at some point in their lives, and 28%
report knowing someone else who has tried it (PATS, 2008). This is identical to rates of lifetime
use reported in 2006 and 2007. Data from the 2008 Monitoring the Future study estimates the
past year use of cough medicine among 8th, 10th, and 12th graders is at 3.6% , 5.3%, and 5.5%,
respectively (MTF, 2008).
Statewide Prevalence: California
In California, statewide norms are provided by the biennial statewide California Student
Survey (CSS), sponsored by the Office of the Attorney General. The current (2007-2008) CSS
combines for the first time alcohol, illicit drugs, diverted prescription drugs and cold/cough
medications (used to get high) into a total percentage of respondents who tried at least one
such drug in their lifetime. The result is that 60% of 9th and 74% of 11th grade students reported
using one of the substances at least once. The most recent survey identified the top 3 major
substance abuse trends in the state of California. Of these 3 trends, 2 were directly related to
prescription and over-the-counter substance abuse.
The survey found that prescription drug abuse by California youth was occurring at an alarming
rate, with 37% of 9th grade and 50% of 11th grade respondents reported using to get high
(“without a doctor’s order to get high or stoned”) at least once in their lifetime either an illicit/
illegal drug or a diverted prescription drug such as painkillers, sedatives or diet pills. The
prescription drugs used most frequently are prescription painkillers, such as Oxycontin® or
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Vicodin®. Twelve percent of 9th and 18% of 11th graders reported using them at least once,
making this by far the second most widely used category of drugs after marijuana. Also, overthe-counter drug abuse data indicates that large numbers of California teens have tried these
products to get high, with 9th graders reporting at a slightly higher rate than 11th graders (26% vs.
25%) (CSS, 2008) (Figure 3).
Source: California Student Survey, 2008
In comparison with other states, California ranked 3rd highest in overall misuse of prescription
psychotherapeutic drugs – a class including prescription pain relievers, tranquilizers, stimulants,
and sedatives (Table 1).
Source: National Survey on Drug Use and Health, SAMSHA, 2007
Although the combined prescription drug abuse rate is among the highest in the nation,
California’s rates of abuse in individual subcategories, such as prescription sedatives,
tranquilizers, and painkillers, were not ranked among the nation’s highest or lowest
(SAMHSA, 2007).
Consequences
Misuse of prescription and over-the-counter drugs can lead to serious health risks. Nationwide,
unintentional overdose deaths involving prescription painkillers increased 117% between
2001 and 2005 from 3,944 to 8,541. Over the same 4-year period, treatment admissions for
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painkiller addictions increased 74% (USDOJ, 2009). In 2006, data submitted from hospitals
across the nation show that there were approximately 741,425 Emergency Department visits
involving nonmedical use of prescription and over-the-counter drug and dietary supplements.
Additionally, 92% of drug-related suicide attempts in 2006 involved misuse of pharmaceuticals
(SAMHSA, 2006).
The consequences of prescription and over-the-counter drug abuse extend beyond the personal
health of those who abuse them. Violent and property crimes associated with prescription drug
diversion and abuse increased nationally between 2003-2007. The Drug Enforcement Agency
reported that the amount of prescription drugs stolen in armed robberies doubled from 0.5
million quantities in 2002 to nearly 1.1 million in 2007 (SAMHSA, 2009). In addition to safety
risks, prescription and over-the-counter drug diversion and abuse pose financial liabilities to the
public as well. Nationally, the estimated cost of prescription drug abuse to public and private
medical insurers is $72.5 billion per year (SAMHSA, 2009).
Contributing Factors
A number of factors contribute to the high rates of prescription and over-the-counter drug abuse
among teens and young adults. First, many teens tend to view these “legal” drugs as safer than
using street drugs (ONDCP, 2008). Additionally, many parents are not aware of teen prescription
drug abuse – only 24% of teens reported that their parents had talked to them about the
dangers of abusing prescription and over-the-counter drugs. The vast majority of parents feel
unprepared to prevent their children from abusing these types of drugs (PATS, 2008). Lastly,
prescription and over-the-counter drugs are viewed as easy to obtain and inexpensive by teens
and young adults (ONDCP, 2008).
Perception of Harm
Many teens abuse prescription and over-the-counter drugs because they believe they are a
safe way to get high (ONDCP, 2008). The dangers of prescription and over-the-counter drugs
are not well understood by many teens and young adults. Forty-one percent of teens indicated
that they believe prescription drugs were “much safer” to use than illegal drugs (PATS, 2008).
Nearly 1/3 of teens (31%) believe that there is “nothing wrong” with using prescription medicines
with a prescription every once in a while. Additionally, 32% of teens say they abuse prescription
painkillers because they believe there are fewer side effects than street drugs (PATS, 2008).
The perception of harm from abuse of over-the-counter cough and cold medicines is increasing
among teens – in 2008, 48% agreed that abusing cough medicine is risky versus 40% in 2004
(PATS, 2008). Despite this positive trend, the majority of teens (52%) still do not believe that
abusing these medicines is dangerous.
Parental Awareness
Research has demonstrated that parents play an important role in preventing their children from
using drugs. A study by SAMHSA showed that youth ages 12-17 whose parents express strong
disapproval of drug use are far less likely to engage in substance abuse (SAMHSA, 2007). Yet,
parents often do not address the issues of prescription and over-the-counter substance abuse
with their children. Only 24% of teens reported having prescription drug abuse discussions with
their parents; 18% reported having cold and cough medicine abuse discussions (PATS, 2008)
(Figure 4).
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The majority of parents do not feel prepared to handle situations involving prescription drug
abuse and over-the-counter substance misuse, with only 34% of parents reporting that they feel
“extremely prepared” to safeguard their medicine cabinets to prevent their child from abusing
prescription drugs (PATS, 2008).
Access and Availability
Young people are able to acquire prescription and over-the-counter drugs easily and rather
quickly. A recent national survey asked 12-17 years old, “which is easiest for someone your
age to buy: cigarettes, beer, marijuana, or prescription drugs such as OxyContin, Percocet,
Vicodin or Ritalin, without a prescription?” Nineteen percent of questioned teenagers reported
that it’s easier to buy prescription drugs than cigarettes, beer, and marijuana. This is a
significant increase compared to 13% teens reporting the same a year ago (CASA, 2009).
Another study reported even higher rates, with approximately 6 out of 10 teens agreeing that
prescription drugs are easier to get than illegal drugs (PATS, 2008). More than 1/3 of teens (8.7
million) also reported that they can get prescription drugs to get high within the day; nearly 1
in 5 teens (4.7 million) can get them within the hour (CASA, 2009). When asked where they
would get prescription drugs, the most common sources were home, parents, and other family
members or friends. In fact, the NSDUH found that half of individuals reporting nonmedical
use of psychotherapuetics got them “from a friend or relative for free” (Figure 5). In a follow-up
question, the majority of these respondents indicated that their friend or relative had obtained
the drugs from one doctor (SAMHSA, 2008).
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Source: National Survey on Drug Use and Health, 2007
Other common sources include obtaining medication from a physician, purchasing the
medications over-the-counter or through rogue internet sites, and theft (usually from friends or
relatives). Of note in regards to internet sales, in a June 2006 CASA report, the internet was
found as a growing source of drugs with increased prescription drug abuse. They also found
that there were no controls on blocking the sale to children and substantial shipments were
from within the United States. (CASA, 2006). Yet, due to the tragic death of a local teen Ryan
Haight – who died at the age of 18 from an overdose of painkillers, including Vicodin® that he
ordered off the internet at age 17 without a legitimate prescription – and the continued advocacy
of his family and the support of several law enforcement and prevention agencies, Congress
passed the Ryan Haight Online Pharmacy Consumer Protection Act in 2008 to combat these
illegal online pharmacies.
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Scope of the Problem in Orange County
Data from the Orange County California Healthy Kids Survey (CHKS) confirms that prescription
and over-the-counter substance abuse is a prevalent issue in Orange County as well. In
recognition of this growing problem, WestEd expanded the CHKS instrument from measuring
only prescription painkiller abuse trends to measuring trends in other prescription and over-thecounter products, including barbiturates, sedatives, stimulants, and cold medicine, in 2007.
Lifetime Use Rates in Orange County
The 2007-2008 California Healthy Kids Survey analyzed the prevalence of specific prescription
and over-the-counter drug abuse rates at a local level. Figure 6 shows lifetime use rates
among 9th and 11th grade students, as well as students at nontraditional school, which include
continuing education, community day schools, and other alternative school types.
Source: California Healthy Kids Survey, 2007-2008
As seen above, the most commonly abused prescription and over-the-counter products in
Orange County are cough and cold medicines and prescription painkillers. With the exception
of the barbiturates, lifetime use of each drug increases between 9th and 11th grade.
In addition to the lifetime use differences between grade levels in Orange County schools,
differences in lifetime use rates are also evident between traditional and nontraditional schools,
with students reporting significantly higher rates of use.
Lifetime Use Rates: Local vs. State
Lifetime use rates of prescription drugs in Orange County, including painkillers, barbiturates,
sedatives, and stimulants, are relatively similar to those of the state of California among 9th
and 11th grade students (Figure 7-8). Among 9th and 11th graders in Orange County, the abuse
of prescription painkillers is slightly below that of the state. In particular, 9th grade students in
Orange County have a slightly higher lifetime usage rate of barbiturates, but this difference
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disappears by the 11th grade. State and local lifetime use rates of sedatives and stimulants are
remarkably similar among 9th grade students. However, there is a more distinct difference in
these rates among 11th grade students, with Orange County 11th graders demonstrating higher
rates of lifetime use (California Healthy Kids Survey, 2008).
Sources: County - California Healthy Kids Survey, 2007-2008; State – California Student Survey, 2008
Despite the similarities in prescription drug abuse rates, abuse rates of over-the-counter cold
medicines in Orange County are considerably different from those of the state (Figure 9). Data
from the California Healthy Kids Survey indicate that abuse rates of cough and cold medicine in
Orange County are significantly lower than those of the state in both 9th and 11th grade students.
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Sources: County - California Healthy Kids Survey, 2007-2008; State – California
Student Survey, 2008
Among prescription and over-the-counter substances, another distinction occurs between
state and local trends. With the exception of barbiturates, Orange County demonstrates larger
increases in lifetime use rates between 9th and 11th grade students than those of the state
(Table 2). This may indicate that a greater proportion of Orange County students experience
their first lifetime use between 9th and 11th grade.
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Regional Prevalence
ADEPT divides Orange County into three service provider areas, identified as: North, Central,
and South. Within each region, data is reported by school district. Appendix C provides a
detailed list of the school districts within each region, as well as the schools within each school
district. Appendix D contains reported lifetime use rates of painkillers, barbiturates, sedatives,
cough medicines, diet pills, and stimulants for each school district in Orange County, grouped by
regions. Appendix E lists the percentage of students across Orange County reporting lifetime
use for each prescription drug and over-the-counter category, including painkillers, barbiturates,
tranquilizers/sedatives, stimulants, inhalants, diet pills, and cold/cough medicines.
Overall, among 9th grade students in Orange County, the two substances with highest lifetime
use rates were cold medicines and prescription painkillers. This trend is true of all school
districts in Orange County with the exception of Santa Ana Unified School District (SAUSD)
in the Central Region of Orange County, where lifetime use rates of diet pills exceeds those
of painkillers (California Healthy Kids Survey, 2007-2008). Of all 9th grade students in Orange
County, those in the Brea-Olinda Unified School District (BOUSD) reported the highest rates
of lifetime painkiller use at 17%, while students in the Tustin Unified School District (TUSD)
reported the lowest rates of lifetime painkiller use at 6% (Figure 10).
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Santa Ana Unified School District (SAUSD), Orange Unified School District (OUSD), Garden
Grove Unified School District (GGUSD), and Anaheim Union High School District (AUHSD) all
reported the highest rates of lifetime cold medicine use among 9th grade students in Orange
County, at 23%. The Tustin Unified School District (TUSD) reported the lowest lifetime use
rates of cold medicine among 9th grade students in Orange County at 7% (Figure 11).
Among 11th grade students in Orange County, the two substances with the highest lifetime use
rates are cold medicines and painkillers. This trend holds for 11th grade students in every school
district with the exception of the Laguna Beach School District (LBUSH) in the South Orange
County Region, where lifetime stimulant use surpasses that of cold medicine (California Health
Kids Survey, 2007-2008). Of all 11th grade students in Orange County, those at Capistrano
Unified School District (CUSD) in the South Region reported the highest rates of lifetime
painkiller use at 27%. At 12%, students at Irvine Unified School District (IUSD), Tustin Unified
School District (TUSD), and Anaheim Union High School District (AUHSD) reported the lowest
rates of lifetime painkiller use among 11th graders in Orange County (Figure 12).
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Students at Santa Ana Unified School District (SAUSD) of the Central Region reported the
highest rates of lifetime cold medicine abuse among Orange County 11th graders at 28%. At
10%, 11th grade students at Irvine Unified School District (IUSD) in the South Region reported
the lowest rates of cold medicine abuse (Figure 13).
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Local Consequences
Data from two primary sources were obtained to analyze the effects of prescription and overthe-counter drug abuse on the health of Orange County residents – the State of California’s
Office of Statewide Health Planning and Development (OSHPD) – Orange County Emergency
Department and Hospital Discharge Data, 2005-2007 and Orange County Sheriff’s Department,
Coroner Division – Drug Overdose Death Data, 2005-2007 (See Appendix B for Description of
Data).
Emergency Department Visits
The number of emergency department visits in Orange County attributed to prescription and
over-the-counter drugs remained relatively stable between 2005 and 2007 (Table 3).
Source: California Office of Statewide Health Planning and Development
In 2005, 2006, and 2007, the ratio of females vs. males visiting Orange County emergency
departments for prescription or over-the-counter drug-related issues was close to 2:1 (Figure
14). Females age 12 – 25 consistently have higher rates of emergency department visits than
males age 12 – 25.
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Figure 15 compares the rates of prescription and over-the-counter drug-related emergency
department visits among two different age groups: youth ages 12-17 and youth ages 18-25.
While rates do not drastically differ between the two age groups, youth ages 18-25 have had
slightly higher numbers of emergency department visits in 2005, 2006, and 2007.
Inpatient Treatment
The total number of youth ages 12-25 treated for prescription and over-the-counter drugrelated issues, measured by Orange County hospital inpatient discharges, increased each year
between 2005 and 2007 (Table 4).
Table 4. RX/OTC-Related Inpatient Discharges
Orange County (12-25 year olds)
Source: California Office of Statewide Health Planning and Development
Inpatient treatment trends for prescription and over-the-counter drug-related issue among
females as compared to males in Orange County are similar to those seen in emergency
department data. In 2005, 2006, and 2007, the ratio of female inpatient treatment versus male
inpatient treatment was nearly 2:1 (Figure 16). Females consistently have higher rates of
prescription and over-the-counter drug-related inpatient treatment instances.
18
Figure 17 illustrates the number of inpatient treatments among different age groups in Orange
County: youth ages 12-17 and youth ages 18-25. The 18-25 year-old age group made up the
majority of prescription and over-the-counter drug-related inpatient treatments in Orange County
in 2005, 2006, and 2007.
19
Overdose Deaths
Between 2005 and 2007, there were 42 deaths in Orange County due to overdoses of
prescription and/or over-the-counter drugs among teens and young adults, ages 12 through 25.
Nine of these deaths occurred amongst residents of the North Region of Orange County, 16
occurred among residents of the Central Region, and 17 occurred among residents of the South
Region. Figure 18 shows the distribution of prescription and over-the-counter drug-related
deaths among the three regions of Orange County.
Source: Orange County Coroner
Data from the Orange County Coroner suggest that there are several noteworthy trends
concerning prescription and over-the-counter drug abuse in Orange County. First and foremost,
deaths due to prescription and over-the-counter drug overdose appear to be on the rise (Figure
19). Between 2005 and 2006, the number of deaths increased from 10 to 12 – a 20% increase.
In 2007, the number of deaths increased to 20 – a 67% increase from 2006 and double the
number of deaths that occurred in 2005.
20
Coroner data also indicates that, among youth ages 12 through 25, deaths attributed to
prescription and over-the-counter drug abuse outpaced deaths attributed to illicit drug abuse
between 2005 and 2007 (Figure 20). The top prescription and over-the-counter drugs
contributing to overdose deaths were Hydrocodone and Acetaminophen (Vicodin®)), Oxycodone
(OxyContin®), Methadone, Diphenhydramine (Benadryl®)) and Morphine*. The most common
illicit drugs contributing to overdose deaths were heroin, cocaine, methamphetamine, and
morphine. The Orange County Coroner includes overdose data attributed to the drug Morphine
in dual categories, as both a legal prescription drug and as an illicit drug.
21
Additionally, the majority of prescription and over-the-counter drug-related deaths among youth
in Orange County (69%) involved multiple substances. Twenty-nine of the 42 deaths occurring
between 2005 and 2007 were attributed to a combination of two or more substances, including
prescription drugs, over-the-counter drugs, and alcohol* (Table 5).
* Data does NOT include substance combinations involving illicit drugs
Lastly, Coroner data indicate that deaths resulting from prescription and over-the-counter drug
abuse are disproportionally higher among males in Orange County than females. Of the 42
prescription and over-the-counter related deaths among youth ages 12 through 25 between
2005 and 2007, 29 deaths (69%) occurred among males, while only 13 deaths (31%) occurred
among females.
22
Orange County Town Hall Meetings
As part of Orange County’s Prescription Drug Initiative, three town hall meetings were
conducted at three different high schools throughout the County. The main purpose of these
town hall meetings was to promote student and parent awareness of issues surrounding
prescription and over-the-counter drug abuse among youth in Orange County. The meetings
also aimed to encourage future participation in drug prevention efforts.
One town hall meeting was conducted in each region of Orange County – North, Central, and
South. Table 6 provides an overview of each town hall meeting.
North Region Town Hall Meeting: Canyon High School
The North Region town hall meeting was conducted on March 25, 2009 at Canyon High School
in Anaheim. There were approximately 200 attendees present, including students and parents
representing Canyon High School and El Rancho Middle School.
Several strategies were employed to inform local community members about this town hall
meeting and to encourage them to attend, including:
• A press release was submitted to the Orange County Register prior to the event.
• The event was published in the Canyon High School Newsletter.
• Promotional fliers were disseminated with online pre-registration forms.
• The event was published in the Anaheim Hills section of the Orange County Register.
• Multiple presentations were given to student and parent groups to advertise the event.
• On the morning of the event, school principals at Canyon High School and El Rancho Middle
School called each student’s home to inform parents of the event.
23
The town hall meeting at Canyon High School was divided into two separate sections. Time in
the first section was dedicated to a speaker’s panel presentation for meeting attendees. Panel
speakers included:
• Law enforcement: Sara Simpson, Special Agent in Charge, California Bureau of Narcotic
Enforcement
• School Administration: Frank Boehler, recently retired Director with the Orange Unified School
District’s Office of Child Welfare and School Attendance
• Community member: Agatha Martino
Sara Simpson presented to the audience on the parallels between prescription and illegal
street drugs. Frank Boehler discussed the implications of prescription and over-the-counter
drug abuse on academics. Agatha Martino presented her personal experience with the
consequences of over-the-counter cough medicine abuse that led to the death of her teenage
daughter – a former student at Canyon High School.
During the second section of the town hall meeting, students and adults were divided into two
separate breakout groups. The adult breakout group attended a lecture by Frank Boehler, who
gave an educational presentation about high-tech drug crimes and how current technology may
be misused by teens to obtain prescription drugs illegally. He also spoke about how to navigate
social networking tools commonly used by teens, such as MySpace and Facebook. The
purpose of the breakout adult group session was to help parents become more educated about
interfacing with the technology their children use.
The student breakout group session aimed to both educate youth about the dangers of
prescription and over-the-counter drug abuse and to seek their feedback about effective ways to
communicate these dangers to their peers. During this breakout session, students were divided
into smaller groups of 6 to 10. They began with a brainstorming session during which they were
presented with two questions:
1. What specific words, phrases, and messages would you include in an awareness and prevention
campaign to communicate a clear message about:
• The dangers of use prescription and over-the-counter drugs for non-medical use; and
• The fact that prescription and over-the-counter drugs are NOT safer than illegal street drugs.
2. What is the best way to communicate these messages to students at your school?
Students were then asked to create a prescription/over-the-counter drug abuse prevention
poster using the messages, slogans, and words they generated during their brainstorming
session.
At the end of the adult and student breakout sessions, a survey was given to each town hall
meeting participant to access satisfaction with the meeting and knowledge/attitude toward
prescription and over-the-counter drug abuse.
24
Findings: Student Breakout Session
The following is a summary of responses and ideas generated during the student breakout
session:
campaign to communicate a clear message about the dangers of prescription and over-the-counter
drugs/safety compared to illegal street drugs?
• They are just as bad
• RX are narcotics
• They can kill you
• They are bad
• They are really bad
• They are uncool
• We all know how it’s going to end
• It’s not worth it
• Don’t do it
• Loss of intellectual stability
• Don’t jump off a roof because you
think you can fly
• Death
• Don’t do it, it will change your life
• Consider what you think as a living
• Use it don’t abuse it
• Why even start?
• Don’t over do it!
• Don’t do drugs
• Don’t use it – life abuse
• MySpace
• Chain e-mails
• YouTube
• Poetry
• Posters on campus
• Drawings & posters
• Facebook
Findings: Survey
A total of 117 completed surveys were collected at the end of the town hall meeting. The 117
survey respondents included 52 students (44.4%), 64 parents (54.7%), and 1 community
member (0.9%)
As seen in Table 7, more than three quarters of the respondents said they are very or extremely
likely to a) use the information or ideas shared by the panel members, as well as b) tell others
about the dangers of prescription and over-the-counter drugs. The majority of the respondents
(59.8%) also reported being very or extremely likely to attend a prescription and over-thecounter drug abuse prevention activity in the future.
25
After attending the town hall meeting at Canyon High School, nearly all of the respondents
agreed or strongly agreed that prescription drugs and over-the-counter drugs are just as
dangerous as street drugs (97.5%). The majority of respondents also agreed or strongly agreed
that a) they feel it’s easy for students to get prescription and over-the-counter drugs (84.6%),
b) they know more about the dangers of prescription and over-the-counter drug abuse among
youth as a result of this meeting (86.3%), and c) they found this town hall meeting to be very
educational (88%) (see Table 8).
26
In response to an open-ended item, about a third (n=38) of the town hall participants said the
meeting increased their awareness or understanding about drugs. A relatively large number
of respondents (n=27) also made comments about the usefulness of the personal stories and
experiences, often mentioning the story about the woman’s daughter. Additional responses and
example quotes related to this item can be seen in Table 9.
Table 10 summarizes the respondents’ suggestions for improving the town hall meeting. The
most frequently mentioned suggestions include a) using more or better examples and stories
(n=23), b) having a better audio visual system (n=9), c) including more information (n=7), and
d) making the meeting more exciting (n=5). Other suggestions and comments can be seen in
the Table 10.
27
Participants were also asked about what other topics they would like to learn more about at
future town hall meetings. There were a wide variety of responses; however, the most common
topics include a) alcohol/drinking and driving (n=11), b) street drugs (n=6), and c) steroids (n=4)
(see Table 11).
28
29
The final table for the town hall meeting at Canyon High School provides all additional
comments made by participants (see Table 12).
30
Data Limitations
• The use of self-administered questionnaire surveys may be subject to participants reporting more
favorable responses than actually experienced. This practice, known as “self-report bias” or “social desirability effect,” occurs when respondents report what they believe the surveyor wants to
know rather than what they really think or how they really behave.
Central Region Town Hall Meeting: Huntington Beach High School
The Central Region town hall meeting was conducted on April 1, 2009 at Huntington Beach
High School in Huntington Beach. The meeting was sponsored by the Friday Night Live Chapter
at Huntington Beach High School – a student group committed to addressing important youth
issues and developing leadership. This group, consisting of 9th through 12th graders, focuses
on creating meaningful projects addressing issues around alcohol, tobacco, and drug use
and violence prevention. The primary purpose of this meeting was to increase participants’
knowledge about prescription and over-the-counter drug abuse among youth. There were
approximately 50 attendees present, including students, parents, and teachers. Approximately
20 of the attendees were monolingual, Spanish-speaking adults. Bilingual audience members
translated the meeting for these adults.
• Fliers advertising the event were posted around the high school campus.
• The event was promoted during the daily Huntington Beach High School announcements in the
days leading up to the town hall meeting.
The Town hall meeting at Huntington Beach High School featured a speaker’s panel
presentation. Panel speakers included:
• Law enforcement: Detective McCain, Huntington Beach Police Department
• School Administration: Jason Ross, Assistant Principal at Huntington Beach High School
• Medical personnel: Dr. Schermerhorn, MD – Psychiatry and Neurology
• Community member: Francine Haight, R.N., prescription drug abuse educator and activist
• Huntington Beach High School Student: Cree Chavez
• Research Analyst/Consultant: Sue Donelson, Community Service Programs, Project PATH
Sue Donelson opened the discussion with an overview of prescription and over-the-counter
drug abuse statistics and trends nationally and locally. Assistant Principal Jason Ross then
addressed the issue of prescription and over-the-counter drug abuse on the Huntington Beach
High School campus. Detective McCain presented to the audience on legal consequences
of prescription and over-the-counter drug abuse and shared several local cases dealing
with this issue. Dr. Schermerhorn, MD, discussed medical and neurological consequences
of prescription and over-the-counter drug abuse. Francine Haight presented her personal
experience with the consequences of prescription drug abuse that led to the death of her
teenage son in 2001. Lastly, Cree Chavez – a 12th grade student at Huntington Beach High
School – spoke about her experiences as a recovering prescription-drug addict.
31
At the end of the speaker’s panel presentations a question and answer session was conducted
to address audience concerns. After the question and answer session, a survey was given
to the town hall meeting participants to access satisfaction with the meeting and knowledge/
attitude toward prescription and over-the-counter drug abuse.
Findings: Survey
survey respondents included 7 students (29.2%) and 17 parents (70.8%).
As seen in Table 13, over 95% of the respondents said they are very or extremely likely to
a) use the information or ideas shared by the panel members, as well as b) tell others about
the dangers of prescription and over-the-counter drugs. Slightly fewer respondents (83.3%)
reported being very or extremely likely to attend a prescription and over-the-counter drug abuse
prevention activity in the future.
After attending the town hall meeting at Huntington Beach High School, all (100%) of the
respondents agreed or strongly agreed that they a) believe prescription drugs and over-thecounter drugs are just as dangerous as street drugs, b) know more about the dangers of
prescription and over-the-counter drug abuse among youth as a result of this meeting, and
c) found this town hall meeting to be very educational. The majority of respondents also agreed
or strongly agreed that they feel it’s easy for students to get prescription and over-the-counter
drugs (95.8%) (Table 14).
32
In response to an open-ended item, nearly 30% (n=7) of the town hall participants said the
meeting increased their awareness or understanding about drugs. Respondents also made
comments about the usefulness of the personal stories and experiences and having a child
present. Additional comments and example quotes related to this item can be seen in Table 15.
Table 16 summarizes the respondents’ suggestions for improving the town hall meeting. The
suggestions include a) increasing attendance of the meeting (n=4), b) using more or better
examples and stories (n=2), c) having a separate meeting for those who speak English (n=2),
and d) making the meeting more exciting (n=1).
33
Participants were also asked about what other topics they would like to learn more about at
future town hall meetings. These responses are summarized below in Table 17.
The final table for the town hall meeting at Huntington Beach High School provides all additional
comments made by participants (see Table 18).
34
Data Limitations
favorable responses than actually experienced. This practice, known as “self-report bias” or
“social desirability effect,” occurs when respondents report what they believe the surveyor wants
to know rather than what they really think or how they really behave.
• The majority of survey respondents were adults, thus the data reflects more adult than youth
perspective regarding town hall meeting content and learnings.
• Although there was a large proportion of monolingual, Spanish-speaking adults at the town hall
meeting, surveys were only provided in English. Thus, these survey results may not reflect the
opinions and learnings of a large proportion of adults at the meeting.
South Region Town Hall Meeting: Tesoro High School
The South Region town hall meeting was conducted on April 14, 2009 at Tesoro High School in
Rancho Santa Margarita. There were 105 attendees present, including students, parents, and
school counselors representing Tesoro High School, Arroyo Vista Middle School, Las Flores
Middle School, Ladera Ranch Middle School, and Marco Forster Middle School.
• A press release was submitted to the Orange County Register prior to the event. The event was
announced in the Our Towns section of the Orange County Register on April 8, 2009, as well as
on the Orange County Register website calendar of events.
• The event was announced in the Tesoro High School PTSA Newsletter.
• Promotional fliers were disseminated to surrounding local schools, including Tesoro High School,
Arroyo Vista Middle School, Law Flores Middle School, Ladera Ranch Middle School, Marco
Forster Middle School, the Ladera Ranch Public Library, the Capistrano Unified School District,
and local Starbucks coffee shops.
• The event was announced on Tesoro High School Listserv Announcements on two separate
occasions.
• The event was published in the Rancho Santa Margarita section of the Orange County Register.
The town hall meeting at Tesoro High School was divided into two separate sections. Time in
the first section was dedicated to a speaker’s panel presentation for meeting attendees. Panel
speakers included:
• Law enforcement: Jennifer Doss and Dan Harward, Special Agents from the California Bureau of
Narcotics Enforcement
• Medical personnel: Dr. Michael Ritter, Emergency Department Physician at Mission Hospital
Regional Medical Center
• Community member: Francine Haight, R.N., prescription drug abuse educator and activist
Law enforcement speakers presented to the audience on the parallels between prescription
and illegal street drugs. The physician discussed the prevalence of youth seeking emergency
medical treatment for prescription and over-the-counter drug-related issues. Francine Haight
presented her personal experience with the consequences of prescription drug abuse that led to
the death of her teenage son in 2001.
35
During the second section of the town hall meeting, students and adults were divided into
two separate breakout groups. The adult breakout group attended a lecture by Registered
Pharmacist Mark Horowitz, who gave an educational presentation including slang terms for
prescription and over-the-counter drugs, signs and symptoms of use, and the “sizzurping”
phenomenon. This was followed by a second presentation by Deputy Lance Christiansen, who
spoke about his personal experiences as a School Resource Officer with prescription and overthe-counter drug abuse issues among youth at the Tesoro High School campus. The purpose of
the breakout adult group session was increase awareness, further educate, and affect attitudes
of parents regarding prescription and over-the-counter drug abuse trends among youth.
The student breakout group session aimed to both educate youth about the dangers of
prescription and over-the-counter drug abuse and to seek their feedback about effective ways to
communicate these dangers to their peers. During this breakout session, students were divided
into smaller groups of 6 to 10. They began with a brainstorming session during which they were
presented with two questions:
campaign to communicate a clear message about:
• The dangers of use prescription and over-the-counter drugs for non-medical use
• The fact that prescription and over-the-counter drugs are NOT safer than illegal street drugs
Students were then asked to create a prescription/over-the-counter drug abuse prevention
poster using the messages, slogans, and words they generated during their brainstorming
session.
At the end of the adult and student breakout sessions, a survey was given to each town hall
meeting participant to access satisfaction with the meeting and knowledge/attitude toward
prescription and over-the-counter drug abuse.
Findings: Student Breakout Session
The following is a summary of responses and ideas generated during the student breakout
session:
campaign to communicate a clear message about the dangers of prescription and over-the-counter
drugs/safety compared to illegal street drugs?
36
• Just Don’t Do It
• Effects everybody differently
• Harmful
• Hugs Not Drugs
• They [Rx] Kill
• Multiple drugs can lead to death
• Drugs R drugs
• Just as dangerous as illegal
• Overdose
• They [Rx] are still drugs
• Death
• Drugs and die
• Coma
• Stay off pills that thrill
• Pharmacies
• Don’t fill your life with drugs, just fill
your life with hugs
• Symptoms: Constipation
• OTC meds: Little do you know…
• Rx drugs are for slugs
• Lock bottles
• Text messaging
• Cool song
• Presentations in class
• Posters
• Concerts
• Meebo
• Bulletins
• Pot lucks
• AIM
• Myspace
• Chat rooms
• Skype
• Twitter
• Personal stories
• Commercials
• Facebook
• People who have
experienced in
• School website
The following items are a few examples of posters that were developed in the second portion of
the student breakout session:
37
Findings: Survey
survey respondents included 69 students (76.7%), 20 parents (22.2%), and 1 community
member (1.1%).
Table 19 illustrates the participants’ response to the town hall meeting. Overall, the participants
reported the likelihood of sharing information learned from the town hall meeting. Approximately
3 out of 4 participants reported that they are very or extremely likely to “use the information or
ideas shared by the panel members” followed by “tell others about the dangers of prescription
and over-the-counter drugs” (64.4%). Over half of the participants (52.8%) reported being very
or extremely likely to attend a prescription and over-the-counter drug abuse prevention activity
in the future.
The participants were asked to respond to various questions regarding their knowledge of
prescription drugs following the training (Table 20). The participants’ strongly agree and agree
responses were aggregated. Over four out of five participants reported that their knowledge
increased in the following statements: “I believe prescription and over-the-counter drugs are just
as dangerous as street drugs” (86.4%), “I feel it is easy for students to get prescription and overthe-counter drugs” (80.7%), and “I know more about the dangers of prescription and over-thecounter drug abuse among youth as a result of this meeting” (79.5%). Overall, the participants
felt the town hall meeting was informative (96.6%).
38
The participants were asked various open-ended questions in response to the town hall
meeting. Table 21 illustrates the participants response to what they felt was most useful. A total
of 83 participants commented. Over 22% of the town hall participants (n=19) reported that the
most useful information of the town hall meeting was that prescription drugs are just as bad as
street drugs. The participants (n=16) reported that the second most useful piece of information
from the town hall meeting was general information about drugs. Specific quotes are illustrated
in Table 21.
39
Table 22 summarizes the respondents’ suggestions for improving the town hall meeting. A
total of 60 participants responded. Approximately three out of eight participants (35%) (n=21)
stated that more personal stories and youth stories should be utilized. Additional suggestions
succeeding that included more food (n=7), more graphics and pictures (n=7), more exciting
and fun activities (n=4), more activities in general (n=3), and better advertising (n=3). Other
suggestions and specific quotes are illustrated in Table 22.
40
Participants were also asked what other topics they would like to learn more about at future
town hall meetings. A total of 44 participants responded. The most common topics suggested
by the participants included all drugs, marijuana, street drugs, alcohol, “angel dust,” and
methamphetamines (see Table 23).
41
A total of 24 comments were made of which all, but one, were positive. Specific quotes were:
42
Data Limitations
favorable responses than actually experienced. This practice, known as “self-report bias” or
“social desirability effect”, occurs when respondents report what they believe the surveyor wants
to know rather than what they really think or how they really behave.
• The majority of survey respondents were students, thus the data reflects more youth than adult
perspective regarding town hall meeting content and learnings.
Summary
Each of the three town hall meetings were successful in their goal to promote student and
parent awareness of issues surrounding prescription and over-the-counter drug abuse among
youth in Orange County. Surveys completed by attendees at all three town hall meetings
showed that the vast majority of parents and students both learned more about the dangers of
prescription and over-the-counter drug abuse and would share this knowledge with others.
43
Partnership for a Drug-Free Orange County
Research suggests that another effective strategy to address prescription and over-the-counter
drug abuse in one’s community is to engage the local media; so this became another focus
of the Orange County initiative. Recognizing the great success of the Partnership for a DrugFree America (PDFA) and its award winning advertisements, the County of Orange Health
Care Agency’s ADEPT program contacted PDFA to see how Orange County could utilize their
research-based national public education program addressing prescription and over-the-counter
drugs.
The result of this contact is a new alliance
between the Health Care Agency’s ADEPT and
the PDFA which will allow ADEPT and various
alcohol and other drug community partners to
work directly with local media to disseminate
the Partnership’s prescription drugs messages,
as well as other media creatives on reducing
illicit drug and alcohol use among children and
teens in the communities of Orange County. The
campaign aims to provide families with the tools,
information and support they need to help their
children lead healthy, drug-free lives.
The new alliance entitled “Partnership for a
Drug-Free Orange County,” encourages parents
to have regular conversations with their children
regarding the dangers of alcohol and other drug
use. Research consistently shows that teens
who learn a lot about the risks of drugs at home
are up to 50% less likely to use than those who
do not get that crucial message at home. Yet
many parents have difficulty talking with their
kids about drugs and alcohol and the campaign
strives to equip parents with the tools they need to begin and keep the dialogue open around
substance abuse.
44
Strategic Planning Session
The final objective of the yearlong Prescription Drug Initiative was to convene a Strategic
Planning Session, which brought together the members of the Task Force along with other
community stakeholders to review data, other promising strategies to address prescription and
over-the-counter drug abuse, and to develop recommendations for next steps in Orange County
(Appendix D lists individuals who attended the session).
On Tuesday, May 5, 2009 the Prescription Drug Strategic Planning Session was held in the
auditorium of the Pacific Coast Recovery Center, and was facilitated by Erica Leary, MPH,
Program Manager for the North Coastal Prevention Coalition in north San Diego County. Ms.
Leary was hired as a consultant to assist with the facilitation of the session and to assist the
group with the prioritization of the prevention recommendations.
The session was based on a model of change developed by the Community Anti-Drug
Coalitions of America (CADCA) which utilizes the Strategic Planning Framework (SPF). This
process that CADCA suggests is aimed at assisting community coalitions to implement the
planning elements of the SPF, which ultimately produces strategic goals, objectives, outcomes,
a logic model, a theory of change, a strategic plan, and an action plan (CADCA, 2007). Due to
time constraints, the Strategic Planning Session was only able to address a few of these items,
but the Task Force plans to build upon the recommendations from the Session and develop a
more comprehensive approach to addressing the issue.
Problem Statements, Contributing Factors (But Why? and But Why
HERE?)
The session began with a welcome and introductions, and then jumped into developing problem
statements. Participants agreed on the following problem statements:
• Too many young people are abusing prescription drugs; and
• Too many young people are abusing over-the-counter (OTC) medications.
The following global contributing factors were identified:
• Perceived harm (Rx and OTC are viewed as less harmful than illicit drugs);
• Easy access (Rx and OTC medications are easy for youth to get);
• Lack of parental awareness (parents don’t know that Rx and OTC medications are abused by
youth); and
• Less shame/stigma (abusing Rx or OTC medications is not viewed as negatively as illicit drug
use).
As for local contributing factors (But Why HERE?), the participants were divided into four groups
and asked to brainstorm how the above contributing factors impacted residents of Orange
County. Following the small group brainstorm, the large group was asked to “vote” on what
they believed to be the priority issues. Each participant was given 5 dots to vote. The numbers
indicate the total votes for each local contributing factor. The following are the suggested
factors, with local contributing factors ranked below them.
45
Perceived harm (Rx and OTC are viewed as less harmful than illicit drugs)
• Social norm (Rx drugs are FDA approved and prescribed by doctors who ‘do no harm’ – not the
same as illicit drugs) [15]
• Technology [1]
• Social acceptability (lots of people take medicine) [6]
• Media/advertising (medicine will solve everything)
Easy access (Rx and OTC medications are easy for youth to get)
• In the home [12]
• Lack of pharmacy coordination/communication re: Rx drugs [5]
• Physician over-prescribing [2]
• Internet access [2]
• No age or quantity limit on OTC medications [2]
• Easily purchased at store (OTC) [2]
• Fewer legal consequences than illicit drugs [2]
• Over the border
• Relatively inexpensive
• Doctor shopping and Medicaid fraud
• Easy to find someone else selling it
• Other peoples’ homes (friends, grandparents), “pharming” parties
Lack of parental awareness (parents don’t know that Rx and OTC medications are
abused by youth)
• Lack of knowledge [16]
• Denial [6]
• Media normalizing use of meds (ads, magazines) [3]
• Belief that Rx and OTC are safer [1]
• Some parents might be using/supplying
• Not knowing how they are used to get high
• Unsuspecting
Less shame/stigma (abusing Rx or OTC medications is not viewed as negatively
as illicit drug use)
• No stigma with use, compared to illicit drug use [13]
• Use of Rx drugs is normalized due to widespread prescribing [4]
• So many people use Rx drugs they are viewed as less harmful [1]
• Media/Hollywood influence, Rx drug abuse not as shamed in celebrity news
46
• Higher socioeconomic status
• Legitimate uses for Rx drugs make them more acceptable
• Can get from home medicine cabinets (not a drug dealer)
Brainstorming Prevention Strategies
The next step was to brainstorm prevention strategies to target the top local contributing factors.
After consulting with the group, the facilitator suggested combining the perception of harm and
lack of stigma into one small group to discuss the social norm surrounding prescription drug
abuse because the strategies would likely be very similar.
The groups were divided to brainstorm prevention strategies to address only the top local
contributing factors identified. These included:
Perceived Harm
Social norm (Rx drugs are FDA approved and prescribed by doctors who “do no harm” – not the
same as illicit drugs)
Prevention Strategies
• More presentations for youth and PTAs, town halls [7]
• Cough syrup policy change to be sold like Sudafed behind the counter (identify retail/corporate
partner) [5]
• Partnership with pharmacies (provide info, enhance skills, physical design) including posters and
inserts, award/reward incentive [4]
• Electronic communication [2]
• Media/Partnership For a Drug Free America
Lack of Parental Awareness
Lack of knowledge on behalf of parents
• Engage parents in prevention – catch earlier [9]
• Media ad campaigns [4]
• Increase awareness of social network sites/misperception and safety [2]
• Increase awareness of signs and symptoms/teach dangers [2]
47
• Access points – lock medications or monitor drop off sites [1]
• Town halls [1]
• Parent newsletters
• Provide resources and talking points
• Increase and encourage alternative family activities
Easy Access
In the home
• Provide information – parent education [2], PSAs, brochures, information on Rx bags and/or
grocery bags when getting medication [7], school listservs, town halls/community meetings [2]
• Changing consequences – offer incentives for turning in unused medications [3]
• Enhancing skills – trainings, facebook fans, train the trainers (schools and administrators),
strategic planning, school resources – websites, on-line workshops, PTAs [1]
• Physical design – physical lock on medicine cabinets
• Increase cultural sensitivity in linguistical language
Lack of pharmacy coordination/ communication re: Rx drugs
• Enforce existing laws (i.e. show ID for scheduled drugs); work with pharmacies to clarify policies with all staff; increase education in pharmacy schools and pharmacy tech programs [8] –
changing consequences
• Precaution signs in pharmacies (educate at the source); similar program in Kentucky [7] – provide
information
• Fax Alert (doctor shoppers, stolen Rx pads); similar program operating in San Diego [3] –
decrease barriers
• CURES (program done by BNE – Bureau of Narcotics Enforcement); increase pharmacy
knowledge of this program [2] – decrease barriers
• Educate pharmacists on how to spot signs of abuse
SWOT Analysis – Strengths, Weaknesses, Opportunities, Threats
After small groups brainstormed prevention strategies for the selected local contributing factors,
the entire group was given sticker dots to vote on which strategies they believed would be most
important to address. Each participant voted for one strategy per small group. The small groups
then reconvened and were asked to conduct a SWOT analysis for the strategy that received the
most votes. The members of one small group (perceived harm – conduct more presentations for
youth and PTA’s) could not stay for the added time of the session and were unable to conduct
this step. The following summarizes the discussion for the remaining three groups:
48
Lack of Parental Awareness → Lack of Knowledge → Engage Parents in Prevention
WEAKNESSES
STRENGTHS
• Family Day Campaign (event already in
existence to build upon)
• Hard to get parent involvement
• Parents want the best for their kids
• Childcare issues
• Solidarity of parents together
• Parents are busy
• We do some of this work already
OPPORTUNITIES
THREATS
• PTA meetings
• No childcare
• School drop off/pick up locations to
reach parents
• No food
• Pride hours
• Sporting events, gymnastics
• Buy prevention banner
Easy Access → Availability in the Home → Implement Pharmacy Bag Campaign
WEAKNESSES
STRENGTHS
• Relatively inexpensive
• People don’t look at campaign
• Reach large numbers (specific to those
filling Rx)
• Message can be improperly targeted
OPPORTUNITIES
THREATS
• Get more pharmacies on board
• Resistance from pharmacies
• Teachable moment
• Funding
• Pharmacy to promote self
• Environmental concerns (move away
from bags)
• Get message across
Easy Access → Lack of Pharmacy Communication/Coordination →
Enforce/Educate about Existing Laws
STRENGTHS
• Already existing laws (don’t need to make
new ones)
WEAKNESSES
• Lack of agency recognition
• Education and training are what we do
(coalition/task force expertise)
OPPORTUNITIES
• Develop stronger relationships with
pharmacies and healthcare providers
• New partnerships and alliances
• Opportunity to find alliances with outside
healthcare organizations (i.e. schools)
THREATS
• Pharmacies that are not on board
• Pharmacies understaffed/lack of time
for training
• Lack of incentive
49
Conclusion
The abuse of prescription and over the counter drugs is a public health issue of concern,
particularly among teens, both locally and throughout the United States. More young people
ages 12-17 abuse prescription drugs than any other illicit drug except marijuana – more than
cocaine, heroin, and methamphetamine combined (SAMHSA, 2008). Prescription and over-thecounter drug abuse has many dimensions, and causes and no single program can address the
magnitude of the issue or the diverse factors underlying it. It is a complex problem that requires
a comprehensive approach and participation from stakeholders in multiple sectors.
Through this unique funding opportunity, Orange County has been able to better position itself
to address the prescription and over-the-counter drug abuse problems within the County. Many
partnerships, resources, and opportunities have been identified and there is an eagerness to
review and discuss next steps, including identifying joint opportunities for community awareness
and advocacy, and the exploration of more coordinated strategies to prevent prescription and
over-the-counter drug abuse. By building on the accomplishments of this past year of research,
data collection, education, and strategic planning, Orange County can collectively build a
local movement to address the issue by sharing this report and findings with key community
stakeholders, leaders and task force members in an effort to increase motivation and willingness
to participate in future drug abuse prevention efforts.
50
References
Banerji S and Anderson IB. (2001). Abuse of Coricidin HBP Cough and Cold Tablet: episodes
recorded by a poison center. Am J Health Syst Pharm.; 58: 1811-1814.
Bobo WV and Fulton RB. (2004). Commentary on: severe manifestations of Coricidin
intoxication. Am J Emerg Med.; 22: 624-625.
Bryner JK, Wang UK, Hui JW, Bedodo M, MacDougall C, Anderson IB. (2006)
Dextromethorphan Abuse in Adolescent: An Increasing Trend: 1999-2004. Arch Pediatr Adolesc
Med.; 160: 1217-1222.
Califano JA. (2007). High Society: How Substance Abuse Ravages America and What to Do
About It. Perseus Publishing, New York, 2007.
California Healthy Kids Survey (2008). Technical Report Secondary 2007-2008 Orange County,
Core Module A. http://www.wested.org/chks/pdf/rpts_dl/fo6s_30_30000_ca.pdf
California Student Survey (2008). California’s Office of the Attorney General. http://www.
wested.org/chks/pdf/cssinchksformat07_08.pdf
Centers for Disease Control (CDC) (2007). Unintentional Poisoning Deaths, United States,
1999-2004. MMWR; 56(05); 93-96. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5605a1.
htm
Community Anti-Drug Coalitions of America. (2007). Planning Primer: Developing a Theory of
Change, Logic Models, and Strategic and Action Plans. http://www.coalitioninstitute.org/SPF_
Elements/Planning/PlanningPrimer-01-2007.pdf
Drug Abuse Warning Network (DAWN) Report (2004). Oxycodone, Hydrocodone, and Polydrug
Use, 2002. http://www.oas.samhsa.gov/2k4/oxycodone/oxycodone.pdf
Monitoring the Future (MTF) Survey (2008). National Institute of Drug Abuse. http://
monitoringthefuture.org/
National Center on Addiction and Substance Abuse (CASA) (2009). National Survey of
American Attitude on Substance Abuse XIV: Teens and Parents. http://www.casacolumbia.org/
absolutenm/articlefiles/380-2009%20Teen%20Survey%20Report.pdf
National Center on Addiction and Substance Abuse (CASA) (2006). “You’ve got drugs!”
Prescription drug pushers on the internet. 2006 update. A CASA White paper. http://www.
casacolumbia.org/pdshopprov/files/you_ve_got_drugs.pdf
Office of National Drug Control Policy (ONDCP) (2008). “Prescription for Danger: A Report
on Prescription and Over-the-Counter Drug Abuse Among the Nation’s Teens.” http://www.
theantidrug.com/pdfs/prescription_report.pdf
Partnership Attitude Tracking Study (PATS) Teens 2007 Report. (2008). Partnership for a Drug
Free America. http://italy.usembassy.gov/pdf2008/other/ParentsSurvey.pdf
51
Partnership for a Drug Free America (2009). The Partnership Attitude Tracking Study (PATS)
Teens 2008 Report. http://www.drugfree.org/Files/full_report_teens_2008
Substance Abuse and Mental Health Services Administration (SAMHSA) (2008). Results from
the 2007 National Survey on Drug Use and Health: National Findings. Office of Applied Studies,
NSDUH Series H-34, DHHS Publication No. SMA 08-4343. Rockville, MD.
Substance Abuse and Mental Health Services Administration (SAMHSA) (2009). Results from
the 2008 National Survey on Drug Use and Health: National Findings. Office of Applied Studies,
NSDUH Series H-34, DHHS Publication No. SMA 08-4343. Rockville, MD.
US Department of Justice (USDOJ). (2009) National Prescription Drug Threat Assessment.
National Drug Intelligence Center. http://www.usdoj.gov/ndic/pubs33/33775/33775p.pdf
52
Appendix A - Orange County Prescription Drug Task Force
Carol Barnes
4th District Parent Teacher Association
Celeste Bentley, MPH, CHES
Project PATH – North
Marianne Cadiz, MPH
Project PATH – Central
Sue Donelson, MPH
Gwen Drenick, MPH, CHES
National Council on Alcoholism and Drug
Dependency, Inc.
Community Alliance Network
Francine Haight, RN
Ryan’s Cause, Inc.
Aimee Hendle
Community Alliances for Drug Free Youth
Romeo Howe
Consultant
Clarice Kavanaugh
Abbott Pharmaceuticals, Inc.
Marianne Mullen
Dependency, Inc.
Michelle Poisson
Phil Falcetti, MPH
Alcohol and Drug Education and Prevention Team
1st Lt. Ruel Fuentecill, MPA
Alcohol and Drug Abuse Services,
Prevention Team
Dependency, Inc.
California National Guard
MSG. Scott Gaukel
Terah Glass, CHES
Dependency, Inc.
Chip Pope
Rebeka Sanchez, MPH, CHES
Sara Simpson
Bureau of Narcotic Enforcement
Irene Umipig, MPH
Dan Gleason, MPH
Joyce Gore, MPH
Project PATH
53
Appendix B – Description of Data Sources
National
• Monitoring the Future (MTF) – conducted by the U.S. Department of Health and Human
Services: National Institute on Drug Abuse (NIDA)
o MTF is a nationwide survey conducted annually since 1975 as part of a long-term study. It is
designed to generate data on current trends of smoking, drinking, and drug use in American
youth and young adults. MTF includes information on trends of legal and illegal drug use, as
well as trends in perceived risk and personal disapproval associated with each drug.
• National Survey on Drug Use and Health (NSDUH) – conducted by the U.S. Department of
Health and Human Services: Substance Abuse and Mental Health Services Administration (SAMHSA)
o NSDUH has been conducted by the Federal Government since 1971 and measures the use
of illegal drugs (including non-medical use of prescription drugs) alcohol, and tobacco by the
U.S. population. The Survey provides yearly data on a national and state level.
• Partnership Attitude Tracking Study (PATS) – conducted by Partnership for a Drug Free
America
o PATS is an annual study that is the largest drug-related attitudinal tracking study in the
country. The survey is conducted within two samples in the United States: students in grades
7 through 12 and parents.
• Youth Risk Behavior Survey (YRBS) – conducted by the U.S. Department of Health and
Human Services: Centers for Disease Control and Prevention (CDC)
o YRBS is a national school-based survey that reports on six categories of priority health-risk
behaviors among youth and young adults, including tobacco use, drug/alcohol use, sexual
behaviors, unhealthy dietary behaviors, and physical activity, and behaviors contributing to
injuries and violence.
Statewide
• California Healthy Kids Survey (CHKS): Aggregate Report – conducted by the California
Department of Education
o CHKS is conducted to collect data on the health risks and resilience of students in the State
of California. CHKS is a comprehensive youth self-report survey that provides health risk
assessment information to assist schools and community groups in preventing youth healthrisk behaviors, including alcohol, tobacco, and drug use. The 2007-2008 CHKS Aggregated
Report includes data from 667,610 students in 7th, 9th, and 11th grades in traditional and
nontraditional schools across the state of California.
• California Student Survey (CSS) – conducted by the California Attorney General’s Office:
Crime and Violence Prevention Center
o CSS is a statewide biennial research survey that collects data on substance use from
California students in grades 7, 9, and 11. The survey is a mandated statewide project
conducted since 1985. It provides a snapshot of student’s health-related and risk-taking
behaviors, including drug, alcohol, and tobacco use. The 12th biennial CSS includes feedback
from 13,930 students from 115 public middle and high schools.
54
Local
• California Health Kids Survey (CHKS): Orange County – conducted by the California
Department of Education
o The 2007-2008 CHKS Orange County Report includes data from 73,212 students in 7th, 9th,
and 11th grades in traditional and nontraditional schools across Orange County.
o Data Limitations:
■ Due to the CKS reporting formats, data is available by school district and not by
city. Data cannot be broken down by city due to school district boundaries that cross
multiple city borders.
■ With the exception of the inhalant category, the data collected on prescription and
over-the-counter drugs are limited to lifetime use prevalence and does not include
information such as past 30 day use or whether or not the respondents report ever
being high off the prescription or over-the-counter substance.
■ The use of a self-administered questionnaire may be subject to participants reporting
more favorable responses than actually experienced. This practice is known as selfreport bias or social desirability effect. This means that respondents may report what
they think the surveyor wants to know rather than what they really think or how they
really behave.
• State of California’s Office of Statewide Health Planning and Development (OSHPD) –
Orange County Emergency Department and Hospital Discharge Data, 2005-2007
o Data Parameters:
■ Date of Emergency Department visit or Hospital Discharge between January 1, 2005 –
December 31, 2007
■ Age 12 – 25 years
■ Resident of Orange County
■ Principal diagnosis ICD-9 code 965.09, 965.4, 965.8, 967.8, 967.9, 969.4, 969.7, 970.1,
970.9 or 975.4 (refer to Appendix A)
o Data Limitations:
■ Due to small sample size, caution should be taken in making inferences or
generalizations to the larger population of 12 to 25 year-olds in Orange County.
■ Data are included based on ICD-9 code and may include cases in which the individual
ingested prescription and/or over-the-counter drug(s) without the intention of abuse
(i.e.; substance taken in error, accidental overdose, etc.)
■ Data are provided by each hospital in Orange County. In some instances, an Orange
County hospital may have provided treatment to a non-resident. Likewise, there may
be instances in which an Orange County resident received treatment for a prescription
or over-the-counter drug-related issue in a hospital outside of Orange County. Thus,
the total number of emergency department visits and hospital discharges does not
necessarily reflect the exact number of Orange County residents who received
treatment for prescription or over-the-counter drug-related issues.
55
• Orange County Sheriff’s Department, Coroner Division – Drug Overdose Death Data,
2005-2007
o Data Parameters:
■ Date of Death between January 1, 2005 – December 31, 2007
■ Age 12 – 25 years
■ Hospital in Orange County
■ Cause of death involved prescription and/or over-the-counter drug(s)
o Data Limitations:
■ Due to small sample size, caution should be taken in making inferences or
generalizations to the larger population of 12 to 25 year-olds in Orange County.
■ Data are sorted by cause of death only, thus there is no method to determine intentions
or actions of the individual leading up to the event of death. (i.e.; data may include
cases of suicide, accidental overdose, etc.)
56
Appendix C – School Districts and Schools in Orange
County by Region
North Region of Orange County
The North Region of Orange County consists of the following five (5) school districts:
1. Anaheim Union High School District (AUHSD)
The cities of Anaheim, Cypress, and La Palma are served by AUHSD:
Anaheim
• Anaheim High School
• Katella High School
• Loara High School
• Magnolia High School
• Savannah High School
• Western High School
Cypress
• Cypress High School
La Palma
• J.F. Kennedy High School
2. Brea-Olinda Unified School District (BOUSD)
The city of Brea is served by BOUSD:
• Brea High School
3. Fullerton Joint Union High School District (FJUHSD)
The cities of Fullerton, Buena Park, and La Habra are served by FJUHSD:
Fullerton
• Fullerton Union High School
• Sunny Hills High School
• Troy High School
Buena Park
• Buena Park High School
57
La Habra
• La Habra High School
• Sonora High School
4. Los Alamitos Unified School District (LAUSD)
The city of Los Alamitos is served by LAUSD:
• Los Alamitos High School
5 Placentia-Yorba Linda Unified School District (PYLUSD)
The cities of Placentia, Yorba Linda, and Anaheim are served by PYLUSD:
Anaheim
• Esperanza High School
Placentia
• El Dorado High School
• Valencia High School
Yorba Linda
• Yorba Linda High School
Central Region of Orange County
The Central Region of Orange County consists of the following six (6) school districts:
1. Huntington Beach Union High School District (HBUHSD)
The cities of Huntington Beach, Fountain Valley, and Westminster are served by HBUHSD:
Huntington Beach
• Huntington Beach High School
• Edison High School
• Marina High School
• Ocean View High School
Fountain Valley
• Fountain Valley High School
Westminster
• Westminster High School
58
2. Garden Grove Unified School District (GGUSD)
The cities of Garden Grove, Westminster, and Fountain Valley are served by GGUSD:
Garden Grove
• Bolsa Grande High School
• Garden Grove High School
• Pacifica High School
• Rancho Alamitos High School
• Santiago High School
Westminster
• La Quinta High School
Fountain Valley
• Los Amigos High School
3. Newport-Mesa Unified School District (NMUSD)
The cities of Newport Beach and Costa Mesa are served by NMUSD:
Newport Beach
• Corona del Mar High School
• Newport Harbor High School
Costa Mesa
• Costa Mesa High School
• Estancia High School
• Early College High School
• Middle College High School
4. Orange Unified School District (OUSD)
The cities of Orange, Anaheim, and Villa Park are served by OUSD:
Orange
• El Modena High School
• Orange High School
Anaheim
• Canyon High School
59
Villa Park
• Villa Park High School
5. Santa Ana Unified School District (SAUSD)
The city of Santa Ana is served by SAUSD:
• Century High School
• Cesar Chavez High School
• Godinez Fundamental High School
• Lorin Griset Academy
• Middle College High School
• Saddleback High School
• Santa Ana High School
• Segerstrom High School
• Valley High School
6. Tustin Unified School District (TUSD)
The cities of Tustin, Santa Ana, and Irvine are served by TUSD:
Tustin
• Tustin High School
Santa Ana
• Foothill High School
Irvine
• Arnold Beckman High School
South Region of Orange County
The South Region of Orange County consists of the following four (4) school districts:
1. Capistrano Unified School District (CUSD)
The cities of San Clemente, Dana Point, San Juan Capistrano, Laguna Niguel, Aliso Viejo,
and Rancho Santa Margarita are served by CUSD. Additionally, the communities of Las
Flores, Coto de Caza, Dove Canyon, Ladera Ranch, and Wagon Wheel are served by
CUSD. The following high schools are a part of CUSD:
• Aliso Niguel High School
• Capistrano Valley High School
• Dana Hills High School
60
• San Clemente High School
• San Juan Hills High School
• Tesoro High School
2. Saddleback Valley Unified School District (SVUSD)
The cities of Mission Viejo, El Toro, Laguna Hills, Lake Forest, Rancho Santa Margarita,
Foothill Ranch, and Trabuco Canyon are served by SVUSD. The following high schools are
a part of SVUSD:
• El Toro High School
• Laguna Hills High School
• Mission Viejo High School
• Mira Monte High School
• Trabuco Hills High School
3. Laguna Beach Unified School District (LBUSD)
The city of Laguna Beach is served by LBUSD. The following high school is part of LBUSD:
• Laguna Hills High School
4. Irvine Unified School District (IUSD)
The cities of Irvine and Tustin are served by IUSD. The following high schools are part of
IUSD:
• Creekside High School
• Northwood High School
• Irvine High School
• San Joaquin High School
• University High School
• Woodbridge High School
61
Appendix D – Orange County Rx/OTC Lifetime Use
by Regions
62
63
64
Appendix E –Orange County Rx/OTC Lifetime Use by Rx/
OTC Drugs
In relation to prescription and over-the-counter drugs, the California Healthy Kids Survey
(CHKS) asks students – “During your life, how many times have you used or tried…” The
following tables reflect the results of the 2007-2008 Orange County CHKS survey in percentiles.
Prescription Pain Killers
lifetime use
0 times
1 time
2-3 times
4 or more times
th
7 Grade
n/a
n/a
n/a
n/a
th
9 Grade
90
3
3
4
th
Nontraditional
65
6
9
20
th
Nontraditional
90
2
4
4
11 Grade
83
4
5
8
Barbiturates
lifetime use
0 times
1 time
2-3 times
4 or more times
th
7 Grade
n/a
n/a
n/a
n/a
th
9 Grade
97
1
1
1
11 Grade
97
1
1
1
Tranquilizers or Sedatives
lifetime use
0 times
1 time
2-3 times
4 or more times
th
7 Grade
n/a
n/a
n/a
n/a
th
9 Grade
96
1
1
2
th
11 Grade
93
2
2
3
Nontraditional
81
4
5
9
Ritalin or Adderall (RX Stimulants)
lifetime use
0 times
1 time
2-3 times
4 or more times
th
7 Grade
n/a
n/a
n/a
n/a
th
9 Grade
96
1
1
2
th
11 Grade
93
2
2
3
Nontraditional
81
4
5
10
65
Cold/Cough Medicines
th
9 Grade
83
3
5
9
th
9 Grade
94
1
2
3
lifetime use
0 times
1 time
2-3 times
4 or more times
7 Grade
n/a
n/a
n/a
n/a
lifetime use
0 times
1 time
2-3 times
4 or more times
7 Grade
n/a
n/a
n/a
n/a
th
th
Nontraditional
66
7
10
18
th
Nontraditional
87
2
3
7
11 Grade
81
4
5
11
Diet Pills
66
th
11 Grade
94
1
1
3
Appendix F - Strategic Planning Session Participants
Marianne Cadiz, MPH
Frank Hernandez, MPH, CHES
Teri Christensen
Romeo Howe
Ryan Crowdis, MSW, PPS
Erica Leary, MPH (Facilitator)
Sue Donelson, MPH
Anthony Pang
Gwen Drenick, MPH
Michelle Poisson
Suzanne Etheridge, MFT
Leigh Poirier, MEd
Cheri Fleming
Rebeka Sanchez, MPH, CHES
Terah Glass, CHES
Fabiola Soto
Martha Espiritu
Pauline Stauder, MPH, CHES
Dan Gleason, MPH
Grace Tan, MPH
Francine Haight, RN
Partnership for a Drug-Free America
Orange County Department of Education,
Alternative, Correctional, Community Educational
Schools & Services
Project PATH – North/Central
National Council on Alcoholism & Drug
Dependency, Inc.
County of Orange Health Care Agency, Alcohol &
Drug Abuse Services – Prevention Team
Ruel Fuentecilla, 1st Lt, USAF, MPA
Dependency, Inc.
Project PATH – North / Central
Ryan’s Cause
California State University of Long Beach
Consultant
North Coastal Prevention Coalition
University of California at Irvine
Alcohol & Drug Education & Prevention Team
University of California at Irvine
Dependency, Inc.
Aimee Hendle
67
DTP310

Prescription and Over-the-Counter Drug Abuse Orange County

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