Prevention

The 1994 Institute of Medicine report recognized that a comprehensive approach that includes prevention is a critical component of any continuum of care.  The below figure is a diagram on the continuum of care with a brief description following that describes the each component.

• Promotion—Designed to create conditions that support behavioral health and the ability of individuals to withstand challenges, promotion strategies can help reinforce the entire continuum of behavioral health services.
• Prevention—The purpose is to “prevent” or at the very least, reduce, the risk of developing an addiction or to even start abusing licit or illicit drugs.
• Treatment—Once diagnosed with an behavioral health disorder, treatment is a critical component in supporting change.
• Recovery—Recovery helps individuals live productive lives and continue their sobriety.

Overall Perspective

Prevention strategies focus on helping individuals and the community at large to develop the knowledge, attitudes, and skills they need to make good choices or change harmful behaviors.

With a Universal approach, any discussion of drug use/abuse/addiction is tailored to the community and community leaders are typically involved with increased messaging to the public and the supportive work needed to reduce the opportunities for use and/or abuse.

The Selective approach looks at helping individuals develop the understanding and personal tools needed to make good choices or even change harmful behavior.

A Universal approach includes efforts to change the local environment and as a result it focuses on a much broader audience.  This format has the potential to produce widespread changes in behavior at the population level. It can create shifts in both individual attitudes and the community norms which can have long-term, substantial effects.

Community Actions

A.         Communication and Education

Communication and Education typically happens through:

• public education,
• social marketing, and
• media advocacy.

It is designed to raise awareness of the issues and improve the community’s understanding on the dangers of drug abuse and proactive steps that can be taken to reduce the risks.  It can be a public education campaign supported by the media, (newspaper, radio, billboards and posters) as well as creating slogans and strong messaging on the harms of drug misuse and abuse.

Essentially there are three levels that take place in Communication and Education:

1. Provide the knowledge for understanding
2. Persuade people to adopt a new behavior by showing the benefit they will receive by doing so;
3. Increase the discussion in the community and build support for a continued effort.

B.         Enforcement (See Sidebar)

Individual Actions

Each of us can take steps to protect ourselves and our family and friends.

A.         As a Patient

When you are a patient, first and foremost, ask questions of your doctor. As noted in other discussions, dependency can happen to anyone, including those who are using prescribed medication.  When you are seeing a doctor, be sure to ask questions.  Why am I being prescribed is this particular medication?  What are the benefits and the side effects?  How long should I use this medication and why? How will I know my treatment is working? What should I avoid (foods, dietary supplements, caffeine, alcohol, etc.) while taking this medication?

More specific questions on opioid medication includes:  (The following questions and answers are taken from: Opioids for Pain, A Public Health Advocacy Program from the Pennsylvania Medical Society. For more information visit www.pamedsoc.org/opioidinfo)

"1. Is this prescription for pain medicine an opioid?

Your doctor can tell you what an opioid is, and how to use it safely to relieve pain.

2.  At what level of pain should I take this prescription?

Opioids are for moderate to severe pain only. Lesser pain should be treated with safer, less powerful drugs.

3.  Do I have to take every pill in the prescription?

No, you should only take the pills when pain levels are moderate to severe. There is no need to use leftover pills.

4.  Where can I safely dispose of remaining pills?

There are several options, depending on where you live. [See "Step 3: Dispose" later in this article for the more information on disposing of your medicines.]

5.  What can I do to avoid addiction?

            Use opioids only when you have moderate to severe pain, and as directed by your doctor. Do not take more pills than your doctor specifies, or more often. Do not save pills for later use. To protect others from addiction, do not give them to friends or family. Dispose of unused pills safely.

6.  What are possible warning signs of dependence or addiction?

There are many, but here are a few: Desire or cravings to use the pain pills without actual pain symptoms. Asking for refills even though pain has subsided. Using more pills than specified or taking them more often. Going to a different doctor for pain medication when you have been refused by your current physician. Using or considering use of illegal drugs such as heroin as a substitute for pain pills.

7.  What can I do if I believe that I might have developed a dependence on this drug?

Talk to your doctor immediately if you or a family member show signs of addiction or dependence. Early detection can help stop the destructive cycle of addiction before it becomes too powerful to resist. Or talk to an addiction counseling organization.

When properly used, opioids for pain provide much-needed relief during the healing and recovery process. But uninformed use or abuse of opioids can lead to addiction and have devastating effects.

If your doctor prescribes an opioid pain medication such as Vicodin, Percocet, hydrocodone or Oxycontin, be sure to ask these simple questions.”

B.  At Home [1]

Remember that 2/3s of teenagers who report abuse of prescription medicine state they are getting them from friends, family and acquaintances. Make sure the teens in your life don't have access to your medicine.

Step 1: Monitor

As a parent, you are in an influential position to immediately help reduce teen access to prescription medicine because medicine is commonly found in the home. But do you know how much you currently in your home? Would you know if some of your pills were missing? From this day forward, make sure you can honestly answer, “Yes.”

Start by taking note of how many pills are in each of your prescription bottles or pill packets.

Keep track of your refills. This goes for your own medicine, as well as for your teens and other members of the household. If you find you need to refill your medicine more often than expected, that could indicate a problem.

If your teen has been prescribed a medicine, be sure you control the medicine, and monitor dosages and refills. You need to be especially vigilant with medicine  known to be addictive and commonly abused by teens.

Make sure your friends and relatives — especially grandparents — are also aware of the risks. Encourage them to regularly monitor their own medicines.

Step 2: Secure

Consider securing your prescriptions the same way you would other valuables in your home, like jewelry or cash. There’s no shame in helping protect those items and the same holds true for your medicine.

Take prescription medicine out of the medicine cabinet and secure it in a place only you know about.

If possible, keep all medicines, both prescription and over-the-counter, in a safe place, such as a locked cabinet your teen cannot access.

Tell relatives, especially grandparents, to lock their medicine or keep them in a safe place.

Step 3: Dispose

Almost all medicines can be safely disposed of by using medicine take-back programs or using U.S. Drug Enforcement Agency (DEA)-authorized collectors. When these options are not available, consumers may also dispose of unused medicine in their household trash.

To see if there is a local medication take-back program happening, you can go to DEA.gov or call 800-882-9539 and find a collection site near you.  Typically any medication – including controlled prescription medication – will be accepted.

“If a take-back or mail back program is not available to you, most other unused or expired medicines can be disposed of in your household trash. First, mix the medicines (do not crush tablets or capsules) with an unpalatable substance such as dirt, kitty litter, or used coffee grounds. Then place the mixture in a container such as a zip-top or sealable plastic bag, and throw the container away in your household trash. Before throwing out your empty pill bottle or other empty medicine packaging remember to scratch out all personal information on the prescription label to make it unreadable.

There are, however, a few prescription medicines that contain controlled substances and are especially harmful if taken accidentally by someone other than the patient. These medicines should not be thrown in the trash, because this method may still provide an opportunity for a child or pet to accidentally take the medicine. If a DEA-authorized collector or drug take-back program is not available, FDA recommends that these medicines be disposed of by flushing when they are no longer needed. The list of medicines recommended for disposal by flushing can be seen at this link.” [2]

For more information about disposing of unused medication, click here.

[1] The Source of the following (and for more information): www.medicineabuseproject.org

[2] U.S. Food & Drug Administration, Medicine Disposal: Questions and Answers.  Obtained from here.