Community Prevention - Mental Health Association Oklahoma

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
FUNDING SOURCES
Strategic Prevention Framework
State Incentive Grant
Coalition Against Prescription and Substance
Abuse of Tulsa (CAPSAT)
Mission and Objective

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
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

4 out of 5 of these deaths involved at least one prescription drug (OSDH 2014)
(OSDH 2014)
Unintentional Poisoning Death Rates Involving at Least One Prescription Opioid by
County of Residence1, Oklahoma, 2007-20122
Cimarron
Texas
Beaver
Woods
Harper
Alfalfa
Nowata
Kay
Grant
Washington
Osage
Woodward
Rogers
Noble
Garfield
Ottawa
Craig
Mayes
Pawnee
Major
Delaware
Ellis
Rates per 100,000
population
Blaine
Roger Mills
Canadian
Washita
Greer
Harmon
Grady
Kiowa
Jackson
of residence was unknown for 14 persons.
Medical Examiner data
22007-2012
PottaSeminole
watomie
Haskell
Hughes
McClain
Pittsburg
Latimer
Le Flore
Pontotoc
Coal
Murray
Stephens
Pushmataha
Cotton
Carter
Johnston
Atoka
Jefferson
Love
1County
Adair
Sequoyah
Okfuskee
Garvin
Comanche
Tillman
State rate2: 11.9
Cherokee
Muskogee
Okmulgee
Oklahoma
Cleveland
Caddo
9.6 – 11.5
<5 deaths
Wagoner
Logan
McIntosh
Beckham
11.6 – 15.9
4.4 – 9.5
Kingfisher
Creek
Lincoln
Custer
Top 5 counties
16.0. – 24.2
Tulsa
Payne
Dewey
Marshall
Bryan
Choctaw
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)
Intentional Analgesic Exposure by Age in Tulsa County (1/1/13-3/31/13)
30.0%
24.2%
21.2%
19.5%
20.0%
17.8%
8.5%
10.0%
3.8%
0.0%
0.0%
0.4%
<6
6-12
1.7%
13-19
20-29
30-39
40-49
50-59
60-69
70-79
2.5%
0.4%
0.0%
80-89
>=90
Unknown
(adult)
At Risk

At what grade are Tulsa County youth reporting using prescription
drugs for non-medical purposes?
30 Day Non-medical Use vs. Lifetime Use
20.0%
18.0%
16.6%
16.0%
13.4%
14.0%
12.0%
14.0%
11.2%
9.6%
10.0%
8.0%
6.8%
6.0%
5.0%
5.7%
4.2%
7.0% 7.2%
6.2%
4.5%
4.0%
2.0%
1.9% 1.8%
0.0%
6th Grade
8th Grade
30-Day Use
30-Day Use
10th Grade
Lifetime Use
12th Grade
Lifetime Use
2008-2012 Oklahoma Prevention Needs Assessment (OPNA)
17.4%
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
Tulsa County
Oklahoma
ODMHSAS 2014
2009
2010
2011
2012
104.99
119.31
89.22
104.53
83.25
88.16
74.65
80.11
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
A closer look at the nonmedical use of
prescription drug
epidemic facing the City
of Tulsa
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)
CAPSAT’s
Target Zip Codes
74105
74115
74133
74136
What are some of the consequences
of Rx use/misuse/abuse?
Consequences
 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.
Tulsa Police Dept. 2014
Self Reported Use of Opiates for Persons
Screened by Oklahoma Department of
Corrections (2012)
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
01-10
11-25
26-50
50+
01-10
11-25
Lifetime
26--50
50+
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%
What is the State of Oklahoma doing to
combat this epidemic?
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 lifethreatening 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
Naloxone Quick Facts:
 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-tpdofficers-carrying-life-saving-kit
Oklahoma Department of Mental Health and
Substance Abuse Services (ODMHSAS)/TPD
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, takeback 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)
Media AwarenessTulsa Transit Ads
(in target zip codes: 74105, 74115, 74133,
74136)
Problem # 1
Easy
Access
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
DO NOT SHARE PRESCRIPTIONS
THE LIFE YOU SAVE MAY BE YOUR OWN
Problem # 2 – Improper Disposal of Rx
Drugs
CAPSAT’S RECOMMENDATION
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
What can be done?
Individuals & Communities Can
Create Environmental Change
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
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)
IS THERE LIGHT AT THE END OF THE TUNNEL?
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
Could that light be getting brighter?
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
A big thank you to our partners. You
make everything possible with your help
and dedication.
CAPSAT Partners
McGee Enterprises
“Local People Solve Local Problems”
For more information, please contact:

Whitney Kemp, CAPSAT Co-Chair
405-522-0075
[email protected]

Stephanie Tillman, SPF SIG Coordinator
918-595-4468
[email protected]

Website: www.capsat.org